Donor issuePermanent Pacing After Cardiac Transplantation in the Era of Extended Donors
Section snippets
Study Population
Between January 2000 and December 2004, 93 patients underwent orthotopic heart Tx at the Toronto General Hospital, University Health Network, Toronto, Ontario. A bicaval anastomosis was used in 88 cases, which represents the study population. This retrospective, consecutive cohort chart review was approved by the local research ethics board.
Data Collection
The University Health Network’s cardiac Tx database (Organ Transplant Tracking Record [OTTR]), Toronto General Hospital medical records and pacemaker clinic
Results
A total of 88 end-stage heart disease patients received orthotopic heart Tx using the bicaval technique between January 1, 2000 and December 31, 2004 at Toronto General Hospital. Two patients had combined heart–kidney Txs. During this interval, 5 patients (not included in this analysis) received a heart Tx in which an atrialatrial anastomosis was used. For these 5 patients the indications for use of biatrial anastomosis were: congenital heart disease (n = 1); prolonged ischemic time (n = 2);
Discussion
The major finding in this study is that the previously reported electrophysiologic advantage of the bicaval surgical technique is no longer applicable in the era of extended donor criteria. The 20.5% post-Tx PPM requirements in our series is significantly higher than previously reported and was directly associated with increasing donor age. Despite the large number of devices in situ pre-Tx, the majority of patients required implantation of additional devices during the post-operative period.
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