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Rejected donor hearts deemed safe for transplantation after stress echocardiography
Donor hearts previously rejected due to age or other risk factors are now being declared viable after passing pharmacological stress echocardiography, according to research presented by Tonino Bombardini, MD, at EUROECHO and other Imaging Modalities 2012 in Athens, Greece.
“[There was] no early graft failure in heart recipients; 94% survival rate at 1-year follow-up,” Bombardino, from the Institute of Clinical Physiology of CNR, Pisa, Italy, told Cardiology Today in an email.
Tonino Bombardini
Between 2005 and 2012, the Aged Donor Heart Rescue by Stress Echo (ADONHERS) Project enrolled 66 rejected heart donors (mean age, 55 years). Forty-seven donors were eligible after legal declaration of brain death and after undergoing dipyridamole (0.84 mg/kg in 6′; n=44) or dobutamine (up to 40 mcg/kg; n=3) stress echocardiography to examine for CAD or cardiomyopathy abnormalities.
Researchers found 35 disease-free hearts eligible for transplantation. Twenty-nine were successfully transplanted in emergency recipients. Normal heart structure and function were declared in 26 patients after angiography, intravascular ultrasound, hemodynamic tests and ventriculography 1 month later. Three patients had minor single-vessel disease. After a median follow-up of 27 months, 26 patients had survived and three died; one at 2 months from general sepsis, one at 15 months from neoplasia and another at 32 months from recurrent multiple myeloma, according to the study abstract.
"One of the advantages of stress echocardiography is its usefulness for evaluating contractile reserve. Evaluation of contractile reserve would be helpful for detecting reversible left ventricular dysfunction (due to catecholamine excess or other causes secondary to acute neurologic insult) in donors who would otherwise be excluded from transplantation consideration because of resting wall motion abnormalities. Hearts with reversible dysfunction could therefore be used instead of being excluded on the basis of resting LV function alone. Furthermore, it may seem more convenient to perform stress echocardiography at the bedside rather than transport the donor to the cardiac catheterization laboratory," wrote Bombardini in an email.
For more information:
Bombardini T. #P182. Presented at: EUROECHO 2012; Dec. 5-8, 2012; Athens, Greece.
Bombardini T. Eur J Echocardiography Abstracts Supplement; 2012:13 (S1), i25.
Disclosure: Bombardini reports no relevant financial disclosures.