Continuous warm reperfusion during heart transplantation.

Abstract

From April 1991 to January 1993, 37 orthotopic heart transplantations were performed at our institution. Conventional preservation technique with cold crystalloid cardioplegia++ and topical hypothermia during storage and implantation was used in the first 15 cases (group A). After January 1992, for the next 22 patients (group B), we administered a first dose of hyperkalemic blood cardioplegia on arrival of the graft and thereafter instituted continuous warm reperfusion by infusion of oxygenated blood with added potassium. The groups were compared retrospectively, and significant differences were observed. In group B, the ischemic time was shortened by 31 minutes, the suture time lasted 12 minutes longer, sinus rhythm recovered spontaneously, the duration of inotropic support was reduced, postoperative arrythmias decreased, length of intensive care and hospital stays were reduced, there was less ischemic damage in the first endomyocardial biopsy sample, and right ventricular pressures a month after operation were lower. Continuous warm reperfusion during implantation of the donor heart is technically feasible and seems to provide enhanced myocardial preservation.