CONGRESS ABSTRACT

Objective: The ideal method of myocardial protection for preservation of the donor heart has not yet been fully defined. We analyzed our long-term experience with heart transplantation (Htx) utilizing three different  cardioplegic solutions. Methods: During a 20-year period (2002-2022), 538 adult individuals underwent isolated Htx at our institution.  To minimize the effect of interfering factors, ten cases in which the Organ Care System TransMedics Inc. was utilized were excluded, resulting in a final cohort of 528 individuals. Patients were stratified into three groups according to the donor heart cardioplegic solution: Celsior (n=301; reference group), HTK Custodiol (n=88) and St. Thomas  (n=139). The perioperative variables and postioperative outcomes were retrospectively reviewed.  The group were similarly matched. Mean follow-up period was 6.2±5.5 years (maximum 20 years).  Results: The rate of primary graft dysfunction (PGD) severe was  10.2% in HTK Custodiol  group, significantly higher than reference group (4.5%; P< 0.04), whereas, in the St.Thomas group the rate was comparable to the reference group (3.6%; P= 0.69). Overall, in-hospital mortality was 12.9%; 13.6% in the in HTK Custodiol  group and 12.9% in the St.Thomas group, comparable to the reference group (P= 0.8 and P= 0.92). Mean follow-up period was 6.2 ± 5.5 years (maximum follow-up time 20 years; 98% complete). Survival at 1, 5 and 12 years in Celsior and in HTK Custodiol  group was  82.6 ± 2.2% vs.  85.2± %3.8,  79.4± 2.4% vs.  82.1± 4.3% and  66.8± 3.3% vs.  62.9±7.3%, respectively (P=0.7) (figure 1A). Survival at 1, 5 and 12 years in St. Tomas group was  81.5± 3.4% ,  71.9± 4.1% and  65.5± 5.2%, respectively, comparable to the reference group (P=0.64) (figure 1B). Conclusions: The use of HTK Cutodiol solution for donor hearts was associated with a significantly higher incidence of PGD when compared to Celsior solution, although this data had no impact  on in-hospital mortality. Long-term survival was comparable among the three groups. HTK Custiodiol solution should be used with caution for preservation of donor hearts.