The following is the summary of “Primary heart dysfunction is greater with combined heart and lung compared with isolated heart procurement” published in the January 2023 issue of Thoracic and cardiovascular surgery by Ram, et al.
Lung recruitment, cannulation, and preservation needs are all different for combined heart and lung (CHL) procurement compared to isolated heart (IH) procurement. Their study’s primary objective was to determine whether differences in CHL versus IH procurement are associated with an increased risk of primary graft dysfunction (PGD) following heart transplantation (HT). Researchers evaluated 175 patients getting HT at a single facility between 1999 and 2019. Patients were categorized as either IH (n=61) or CHL (n=114) procurement groups.
Long-term survival and post-transplant graft dysfunction (PGD; as defined by the International Society of Heart and Lung Transplantation consensus statement) were used as end goals. PGD occurred in 53.5% of CHL recipients and 16.4% of IH recipients, respectively (P<.001). The probability of PGD was shown to increase by 4.6 times after controlling for other factors in a multivariate analysis of CHL procurement (95% CI: 2.1-11, P<.001). Overall survival did not differ substantially by procurement group in either univariate or multivariate analysis (log-rank P=.150; hazard ratio =1.13; 95% CI = 0.68-1.88; P=.646).
Recipients of HT found no higher risk of PGD when abdominal organs were removed at the same time. The propensity-matched analysis did not change these findings. Donating both a heart and lungs at once increases the chance of PGD. Additional prospective studies are required to confirm the findings of this hypothesis-generating investigation.