Long-Term Outcome of Myocardial Protection in Heart Transplantation: Comparison Among 3 Different Solutions.

OBJECTIVES: We analysed our long-term experience with heart transplantation (Htx) utilizing 3 different cardioplegic solutions. METHODS: During a 20-year period, 538 adult individuals underwent isolated Htx at our institution. Ten cases in which the Organ Care System TransMedics Inc was utilized were excluded, resulting in a final cohort of 528 individuals. Patients were stratified into 3 groups according to the donor heart cardioplegic solution: Celsior (n = 301; reference group), HTK-Custodiol (n = 88), and St Thomas (n = 139). Mean follow-up period was 6.2 ± 5.5 years (maximum 20 years). RESULTS: The rate of severe primary graft dysfunction (PGD) was 10.2% in the HTK-Custodiol group, significantly higher than the reference group (4.5%; P < .040). Overall, in-hospital mortality was 12.9%: 13.6% in the HTK-Custodiol group and 12.9% in the St Thomas group, comparable to the reference group (P = .803 and P = .924). Survival at 1, 5, and 12 years in the Celsior and HTK-Custodiol groups was 82.6 ± 2.2% vs 85.2±3.8%, 79.4 ± 2.4% vs 82.1 ± 4.3%, and 66.8 ± 3.3% vs 62.9 ± 7.3%, respectively (P = .706). Survival at 1, 5, and 12 years in the St Tomas group was 81.5 ± 3.4%, 71.9 ± 4.1%, and 65.5 ± 5.2%, respectively, comparable to the reference group (P = .640). Post-transplant rejection rate was similar among the groups. CONCLUSIONS: The use of HTK-Custodiol solution was associated with a significantly higher incidence of PGD when compared to Celsior solution, although this data had no impact on in-hospital mortality. Long-term survival and post-transplant rejection were comparable among the 3 groups. HTK-Custodiol solution should be used with caution for preservation of donor hearts. ERB APPROVAL NUMBER: 215-29042020; May 5, 2020.