Repeated Cardioplegic Arrest of a Donor Allograft during an Adult Orthotopic Heart Transplant-What Can We Learn?
The first heart transplant (OHT) was performed in 1967 at Groote Shuur Hospital in Cape Town, South Africa by Dr. Christiaan Barnard. It remains the only definitive therapy for advanced heart failure today. One of the possible complications is primary graft failure (PGF), defined as severe ventricular dysfunction immediately after transplantation not caused by rejection or infection. PGF is the leading cause of death at 1 and 5 years after OHT. We present the case of a 57 year old man with end-stage chronic systolic heart failure and ischemic cardiomyopathy with a left ventricular assist device in place who underwent OHT. After reperfusion of the donor heart, a 1 cm tear in the donor aorta was discovered that required re-clamping of the aorta to repair. Repeated, antegrade, cold cardioplegia was given to the donor heart, inducing a second episode of cardiac arrest for an additional 14 min. We demonstrate a rarely-utilized technique to protect a donor graft from ischemic injury and reduce the risk of PGF and potentially the need for further postoperative extracorporeal membrane oxygenation (ECMO). Our approach only required standard cardiopulmonary bypass technology which could be a viable option in hospitals where ECMO is limited or not available.
Ering Ng, Cios TJ* and Guvakov D
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