Thoracic transplantationPrimary Graft Failure and Ca2+ Sensitizers After Heart Transplantation
Section snippets
Patients and Methods
Patients (n = 5) undergoing orthotopic heart transplantation and presenting postoperatively with high-dosed catecholamines (>2 mg/h of norepinephrine/epinephrine/milrinone) and reduced ejection fraction (EF<30%) were treated with levosimendan (Simdax, Abbot GesmbH, Vienna, Austria).
The EF was measured first by visual estimation and then using the modified biplane Simpson's method by two different observers. Levosimendan was administered intravenously in a 24-hour continuous infusion (0.10
Results
All patients showed similar demographic data; 80% were men and the overall mean age was 52 years. Dilated cardiomyopathy was the indication in 80% of cases. The average ischemia time of the hearts was 252 ± 28 minutes. The mean donor age was 33 years. Organ preservation was achieved in all cases with UW solution.
The hemodynamic measurements initially showed a MAP of 70 ± 11 mm Hg, a CVP of 17 ± 1.6 mm Hg, a MPAP of 28 ± 3 mm Hg, and a CI of 2.5 ± 0.4 L/min per m2. Two days after treatment with
Discussion
Acute graft failure is a complication associated with poor outcomes after cardiac transplantation. Various pathways contribute to primary heart failure after transplantation, including myocardial stunning, prolonged cold ischemia, right heart failure, arrhythmias induced by reperfusion injury, or inadequate preservation.6 Donor–recipient-related factors, such as depressed cardiac function following brain death may induce primary graft dysfunction.7
Catecholamines as well as phosphodiesterase
References (10)
- et al.
Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST)
Am Heart J
(1999) - et al.
Late vascular complications after extracorporeal membrane oxygenation support
Ann Thorac Surg
(2006) - et al.
Electrophysiologic and proarrhythmic effects of intravenous inotropic agents
Prog Cardiovasc Dis
(1995) - et al.
Outcome of hearts with cold ischemic time greater than 300 minutesA case-matched study
Eur J Cardiothorac Surg
(2005) - et al.
Ca (2+)-sensitisers-a promising option to treat heart failure?
Cardiovasc Drugs Ther
(2005)
Cited by (11)
Compromised right ventricular contractility in an ovine model of heart transplantation following 24 h donor brain stem death
2021, Pharmacological ResearchCitation Excerpt :It may be advantageous to consider the utilisation of other pharmacological (eg. Ca2+ sensitisers/omecamtiv mecarbil) or non-pharmacological (eg. mechanical assist devices) strategies to haemodynamically support the donor and recipient outside of adrenergic agonism [56,57]. The concentration-effect curve to (-)-noradrenaline revealed cardiodepressant effects at higher (~ > 100 nM) concentrations in all groups of hearts and therefore were not a particular feature of BSD or heart transplantation.
Levosimendan as rescue therapy in low output syndrome after cardiac surgery: effects and predictors of outcome
2019, Journal of International Medical ResearchHurdles to cardioprotection in the critically ill
2019, International Journal of Molecular SciencesTransplant patients
2014, Anesthesia and Perioperative Care of the High-Risk Patient, Third Edition
A. Beiras-Fernandez and F.C. Weis contributed equally to this work.