Cardioplegia Solution Related Ventricular Pacing Following Orthotopic Heart Transplantation

Abstract

Purpose Multiple solutions are used for heart allograft preservation. University of Wisconsin (UW) remains the most widely used, although there has been increased utilization of histidine-tryptophan-ketoglutarate (HTK). This study investigated differences in the use of postoperative ventricular pacing (VP) at a single center following a change in allograft preservation from UW to HTK . Methods We conducted a retrospective study of 42 consecutive patients who underwent orthotopic heart transplantation between January 2017 and December 2018. 21 patients received UW-preserved allografts followed by 21 patients who received HTK-preserved allografts. Patient characteristics, comorbidities and complications were reviewed. Duration of VP and inotropic infusions in the postoperative period were compared between the two groups, UW and HTK. Results Table 1 shows pretransplant use of anti-arrhythmics and mechanical support and duration of inotropic support posttransplantation. Figure 1 graphs the number of patients requiring VP from postoperative day 0 to 15. Despite supplemental inotropy in all patients, there was a higher incidence of VP in the first 24 hours in the HTK group compared to UW (43% vs 5%, p=0.01). Preoperative amiodarone use did not correlate with incidence of VP. No patients required a permanent pacemaker. Conclusion Multiple studies have been performed investigating the impact of preservation solutions on heart transplant outcomes with mixed results. This hypothesis generating study suggests a higher incidence of bradyarrhythmias requiring VP in HTK-preserved allografts, warranting validation in larger datasets.