Myocardial protection in heart transplantation using
blood cardioplegia: 12-year outcome of a prospective
randomized trial
Giovanni Battista Luciani, MD,
a
Alberto Forni, MD,
a
Gianluca Rigatelli, MD,
b
Bartolomeo Chiominto, MD,
a
Paolo Cardaioli, MD,
b
Alessandro Mazzucco, MD,
a
and
Giuseppe Faggian, MD
a
From the
a
Division of Cardiac Surgery, University of Verona, Verona, and
b
Division of Cardiology, Regional Hospital Rovigo, Rovigo,
Italy.
BACKGROUND: Blood cardioplegia yields a lower prevalence of right heart failure, arrhythmias, and
myocardial ischemia early after heart transplantation (HTx). Because depolarizing (high [K
+
]) car-
dioplegic solutions may alledgedly cause endothelial damage, the 12-year outcome of a prospective
randomized trial was reviewed.
METHODS: Between January 1997 and March 1998, 47 consecutive patients received crystalloid
(Group 1, n = 27) or blood cardioplegia (Group 2, n = 20). The groups were similarly matched:
recipient age (54 11 vs 55 7 years, p = 0.9), sex (89% vs 90% males, p = 0.9), diagnosis (63%
vs 65% dilated cardiomyopathy, p = 0.8), elevated (4 WU) pulmonary vascular resistance (30% vs
30%, p = 0.9), prior operations (22% vs 30%, p = 0.5), urgent HTx (7% vs 20%, p = 0.2), donor age
(32 11 vs 31 13 years, p = 0.7), donor sex (78% vs 70% males, p = 0.5), donor cause of death
(33% vs 40% vascular, p = 0.5), and global myocardial ischemia (176 51 vs 180 58 minutes
p = 0.5). Hemodynamically unstable donors were more prevalent in Group 2 (15% vs 45%, p = 0.02).
The 45 hospital survivors underwent yearly echocardiography, coronary angiography, and coronary
intravascular ultrasound (IVUS) imaging during follow-up.
RESULTS: During follow-up (10.4 5.2, range, 0.9 –12.7 years), Groups 1 and 2 had comparable
mortality (46% vs 42%, p = 0.7) and cause of death (chronic rejection: 50% vs 50%; neoplasia: 33%
vs 25%, p = 0.8). Survival at 12 years was 50% 12% vs 52% 11% (p = 0.9). Follow-up
echocardiogram showed similar mean left ventricular ejection fraction (LVEF; 47% 12% vs 49%
11%, p = 0.7) and prevalence of LVEF 35% (21% vs 18%, p = 0.8). Prevalence of chronic rejection
was comparable (42% vs 32%, p = 0.1), yet severe allograft vasculopathy (International Society for
Heart and Lung Transplantation cardiac allograft vasculopathy 3) was more prevalent in Group 1 (64%
vs 17%, p = 0.04). Freedom from chronic rejection was higher in Group 2 (44% 15% vs 63%
13%), albeit not significantly (p = 0.5). A trend toward greater prevalence of intimal disease at IVUS
(thickness 0.5 mm) in the proximal and distal left anterior descending artery (67% vs 40%; 58% vs
45%) and higher number of percutaneous coronary interventions (2.7 0.5 vs 1.8 0.3, p = 0.3) was
noted in Group 1.
CONCLUSIONS: Use of blood cardioplegia is safe and results in comparable survival and prevalence of
adverse events late after HTx. The trend towards greater freedom from chronic rejection and more limited
extent of coronary artery disease in grafts protected with blood cardioplegia awaits confirmation.
J Heart Lung Transplant 2011;30:29-36
© 2011 International Society for Heart and Lung Transplantation. All rights reserved.
KEYWORDS:
heart transplantation;
myocardial ischemia;
cardioplegia;
cardiac allograft
vasculopathy;
intravascular
ultrasound
Reprint requests: Giovanni Battista Luciani, MD, Division of Cardiac Surgery, University of Verona, O.C.M. Piazzale Stefani 1, 37126 Verona, Italy.
Telephone: +39-45-812-2485. Fax: +39-045-812-3308.
E-mail address: giovanni.luciani@univr.it
http://www.jhltonline.org
1053-2498/$ -see front matter © 2011 International Society for Heart and Lung Transplantation. All rights reserved.
doi:10.1016/j.healun.2010.08.014