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Hartmuth B. Bittner
Simon W. H. Kendall
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Robert D. Davis
Peter Van Trigt, III
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Ann Thorac Surg 1995;60:47-54
© 1995 The Society of Thoracic Surgeons

Myocardial Performance After Graft Preservation and Subsequent Cardiac Transplantation From Brain-Dead Donors

Hartmuth B. Bittner, MD, PhD, Simon W. H. Kendall, FRCS, Edward P. Chen, MD, Robert D. Davis, MD, Peter Van Trigt, III, MD

Department of General and Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina

Background. This study examined the effects of brain death and graft preservation on right and left ventricular function after subsequent cardiac transplantation.

Methods. Seventy-eight dogs underwent 34 orthotopic complete atrioventricular transplantations using a validated brain-dead organ donor model, hypothermic cardiac preservation, and right and left ventricular function analysis (preload-independent recruitable stroke work). Four groups were studied: controls, transplantation from brain-dead organ donors, graft preservation without brain death, and donor brain death and graft preservation before transplantation.

Results. Without brain death, cardiac arrest alone as well as the combination of cardiac arrest and preservation did not significantly decrease cardiac function after transplantation. After brain death alone, right ventricular and left ventricular function decreased significantly by 30% and 25%, respectively, but subsequent transplantation did not cause further cardiac dysfunction. Preservation after brain death led to a further significant decrease in right ventricular function after subsequent transplantation, and dopamine hydrochloride was required to wean 4 animals from cardiopulmonary bypass.

Conclusions. Brain death causes a significant loss of right and left ventricular function. These injuries are greater in the right ventricle and may contribute to early right ventricular failure after transplantation. Brain death and cardiac preservation interact significantly to impair right ventricular function further. Future studies of graft preservation should use brain-dead organ donors.


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Discussion
Ann. Thorac. Surg. 1995 60: 54. [Extract] [Full Text]



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