Donor issue
Permanent Pacing After Cardiac Transplantation in the Era of Extended Donors

https://doi.org/10.1016/j.healun.2006.07.003Get rights and content

Background

Early results with bicaval anastomosis have shown a decreased requirement for permanent pacing (PPM) after transplantation (Tx). It is unclear whether this remains true in the current era of extended donor criteria. The objective of the present study was to characterize the need for post-Tx PPM requirements in the current bicaval era and to determine factors associated with need for pacing.

Methods

The local cardiac Tx database, hospital records and electrophysiology laboratory database were cross-referenced for information on patients in the pre-, peri- and post-Tx period.

Results

Between 2000 and 2004, 88 patients received a cardiac Tx using bicaval anastomosis. At post-Tx, 18 of 88 (20.5%) patients required a PPM. The incidence of single- and dual-chamber PPM was 31.3% and 68.7%, respectively. Mean donor age for patients requiring post-Tx PPM was 44.7 ± 15.3 years compared with 35.7 ± 14.4 years for those with no PPM requirement (p = 0.019). For every 5-year increase in donor age the risk for post-Tx PPM increased 1.234-fold (95% confidence interval [CI] 1.022 to 1.489, p = 0.0289). Recipient age, gender, amiodarone use, year of transplant, surgeon and surgical times were not associated with PPM requirements after cardiac Tx.

Conclusions

Pacing requirements after heart transplantation, in the era of extended donor criteria, exceed the previously published rates of 0% to 5%. The advantage of bicaval anastomosis in decreasing pacing needs post-Tx does not exist in the era of extended donor criteria, specifically in the older donor age group.

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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