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J Thorac Cardiovasc Surg 1999;118:787-795
© 1999 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

BLOOD VERSUS CRYSTALLOID CARDIOPLEGIA FOR MYOCARDIAL PROTECTION OF DONOR HEARTS DURING TRANSPLANTATION: A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL

From the Division of Cardiac Surgery, University of Verona, Verona, Italy.

Address for reprints: Giovanni Battista Luciani, MD, Division of Cardiac Surgery, University of Verona, O.C.M. Piazzale Stefani 1, Verona, 37126, Italy (E-mail: luciani{at}netbusiness.it).

Objective: To assess the safety and efficacy of myocardial protection of the donor heart during transplantation with the use of blood cardioplegia, a prospective randomized clinical trial was undertaken between January 1997 and March 1998.
Methods: Forty-seven consecutive patients were assigned either to crystalloid (27 patients; group 1) or blood cardioplegia (20 patients; group 2). Comparison of recipient age (54 ± 11 years vs 55 ± 7 years; P = .9), sex (89% vs 90% male patients; P = .9), diagnosis (63% vs 65% dilated cardiomyopathy; P = .8), elevated pulmonary vascular resistance (30% vs 30%; P = .9), prior cardiac operations (22% vs 30%; P = .5), need for urgent heart transplantation (7% vs 20%; P = .2), donor age (32 ± 11 years vs 31 ± 13 years; P = .7), cause of death (33% vs 40% vascular; P = .5), and global myocardial ischemia (176 ± 51 minutes vs 180 ± 58 minutes; P = .5) showed no difference. Hemodynamically unstable donors (15% vs 45%; P = .02) were more prevalent in group 2.
Results: Operative mortality rates (4% vs 5%; P = .8), high-dose inotropic support (41% vs 30%; P = 0.6), and postoperative mechanical assistance (11% vs 10%; P = 0.9) were comparable in the 2 groups. Prevalence of acute right heart failure (27% vs 0; P = .02) and of temporary complete atrioventricular block (52% vs 20%; P = .02) were greater in group 1. Spontaneous sinus rhythm recovery was more prevalent in group 2 (11% vs 40%; P = .02). Higher peak creatine kinase (1429 ± 725 u/L vs 868 ± 466 u/L; P = .01) and creatine kinase MB (144 ± 90 u/L vs 102 ± 59 u/L; P = .06) levels suggested more severe ischemic injury in group I.
Conclusion: Use of blood cardioplegia was associated with a lower prevalence of right heart failure, cardiac rhythm dysfunction, and laboratory evidence of ischemia. (J Thorac Cardiovasc Surg 1999;118:787-95)

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