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Cold ischemia >4 hours increases heart transplantation mortality. An analysis of the Spanish heart transplantation registry

Autores: Valero-Masa, M. J.; Gonzalez-Vilchez, F. ; Almenar-Bonet, L. ; Crespo-Leiro, M. G.; Manito-Lorite, N. ; Sobrino-Marquez, J. M. ; Gomez-Bueno, M. ; Delgado-Jimenez, J. F. ; Perez-Villa, F. ; Loidi, V. B. ; Arizon-el Prado, J. M.; Molina, B. D.; de la Fuente-Galan, L. ; Ocampo, A. P. ; Bravo, I. P. G.; Rabago Juan Aracil, Gregorio; Martinez-Selles, M. (Autor de correspondencia)
ISSN: 0167-5273
Volumen: 319
Páginas: 14 - 19
Fecha de publicación: 2020
Background: Cold ischemia time (CIT) has been associated to heart transplantation (HT) prognosis. However, there is still uncertainty regarding the CIT cutoff value that might have relevant clinical implications. Methods: We analyzed all adults that received a first HT during the period 2008-2018. CIT was defined as the time between the cross-clamp of the donor aorta and the reperfusion of the heart. Primary outcome was 1-month mortality. Results: We included 2629 patients, mean age was 53.3 +/- 12.1 years and 655 (24.9%) were female. Mean CIT was 202 +/- 67 min (minimum 20 min, maximum 600 min). One-month mortality per CIT quartile was 9, 12, 13, and 19%. One-year mortality per CIT quartile was 16, 19, 21, and 28%. CIT was an independent predictor of 1-month mortality, but only in the last quartile of CIT >246 min (odds ratio 2.1, 95% confidence interval 1.49-3.08, p < .001). We found no relevant differences in CIT during the study period. However, the impact of CIT in 1-month and 1-year mortality decreased with time (p value for the distribution of ischemic time by year 0.01), particularly during the last 5 years. Conclusions: Although the impact of CIT in HT prognosis seems to be decreasing in the last years, CIT in the last quartile (>246 min) is associated with 1-month and 1-year mortality. Our findings suggest the need to limit HT with CIT > 246 min or to use different myocardial preservation systems if the expected CIT is >4 h.