Pasrija Chetan, Kon Zachary N, Shah Aakash, Holmes Sari D, Rozenberg Karina S, Joseph Susan, Griffith Bartley P
Department of Cardiac Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.
Department of Cardiac Surgery, Northwell Health, Manhasset, NY.
JTCVS Open. 2023 May 12;15:291-299. doi: 10.1016/j.xjon.2023.04.021. eCollection 2023 Sep.
Implantation of an appropriately sized donor heart is critical for optimal outcomes after heart transplantation. Although predicted heart mass has recently gained consideration, there remains a need for improved granularity in size matching, particularly among small donor hearts. We sought to determine if indexed donor cardiac output is a sensitive metric to assess the adequacy of a donor heart for a given recipient.
A retrospective analysis was performed (2003-2021) in isolated orthotopic heart transplant recipients from the United Network for Organ Sharing database. Donor cardiac output was divided by recipient body surface area to compute cardiac index (donor cardiac index). Predicted heart mass ratio was computed as donor/recipient predicted heart mass. The primary outcome was mortality 1 year after transplant.
Among transplant recipients, median donor cardiac output was 7.3 (5.8-9.0) liters per minute and donor cardiac index was 3.7 (3.0-4.6) liters per minute/m. Predicted heart mass ratio was 1.01 (0.91-1.13). After multivariable adjustment, higher donor cardiac index was associated with lower 1-year mortality risk (odds ratio, 0.92, = .042). Recipients with predicted heart mass ratio less than 0.80 (n = 255) had a lower median donor cardiac index than those with a predicted heart mass ratio of 0.80 or greater (3.2 vs 3.7, < .001). As predicted, heart mass ratio became smaller and the association between donor cardiac index and 1-year mortality became progressively stronger.
Higher donor cardiac index was associated with a lower probability of 1-year mortality among patients undergoing heart transplantation and served to further quantify mortality risk among those with a small predicted heart mass ratio. Donor cardiac index appears to be an effective tool for size matching and may serve as an adjunctive strategy among small donor hearts with a low predicted heart mass ratio.
植入大小合适的供体心脏对于心脏移植术后获得最佳疗效至关重要。尽管预测心脏质量最近已受到关注，但在大小匹配方面仍需要提高精细度，尤其是在小供体心脏中。我们试图确定指数化供体心输出量是否是评估给定受者供体心脏适配性的敏感指标。
对器官共享联合网络数据库中接受孤立原位心脏移植的受者进行回顾性分析（2003 - 2021年）。将供体心输出量除以受者体表面积以计算心脏指数（供体心脏指数）。计算预测心脏质量比，即供体/受者预测心脏质量。主要结局是移植后1年的死亡率。
在移植受者中，供体心输出量中位数为每分钟7.3（5.8 - 9.0）升，供体心脏指数为每分钟3.0 - 4.6升/平方米。预测心脏质量比为1.01（0.91 - 1.13）。多变量调整后，较高的供体心脏指数与较低的1年死亡风险相关（比值比，0.92，P = 0.042）。预测心脏质量比小于0.80的受者（n = 255）的供体心脏指数中位数低于预测心脏质量比为0.80或更高的受者（3.2对3.7，P < 0.001）。正如预测的那样，心脏质量比越小，供体心脏指数与1年死亡率之间的关联就越强。
较高的供体心脏指数与心脏移植患者1年死亡概率较低相关，并有助于进一步量化预测心脏质量比小的患者的死亡风险。供体心脏指数似乎是一种有效的大小匹配工具，并且可能作为预测心脏质量比低的小供体心脏的辅助策略。
