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The impact of ischemic time and procurement distance on long-term survival following heart transplantation in a tertiary care center: 30 years of experience
Topic : interventional cardiology and cardiovascular surgery
Sub-topic : Cardiovascular Surgery - Transplantation
Session type : Poster Session
Authors : S Jia (London,CA), D Nagpal (London,CA), L Goldraich (London,CA), P Pflugfelder (London,CA), RA Davey (London,CA), R Mckelvie (London,CA), S De (London,CA), X Cai (London,CA), SJ Smith (London,CA)
1University of Western Ontario, Schulich School of Medicine and Dentistry - London - Canada
2London Health Sciences Centre, Cardiac Surgery - London - Canada
3London Health Sciences Centre, Cardiology - London - Canada
Purpose: Determining the boundaries of the catchment area for receiving donor hearts has important consequences in the balance between transplant ischemic times and increasing the supply of hearts. This is especially important in countries where there are large geographic distances, such as in Canada.
Methods: A retrospective analysis of all patients since the initiation of the heart transplant program at a tertiary academic center were included. Ischemic time and procurement distance were obtained from the surgical and medical records and survival data was collected for up to 10 years post transplant. Comparisons of mean ischemic time and procurement distance were made between short (3 months), medium (1 year), and long (10 years) term survivors and those that died.
Results: 513 patients between April 1981 and January 2009 were included. Patients that survived 3 months post transplant had a mean ischemic time of 211 minutes whilst those that did not had a mean ischemic time of 202 minutes. After 1-year post transplant, the mean ischemic time was 211 minutes for the survivors and 201 minutes for those that did not survive. And after 10-year post transplant, the mean ischemic time was 216 minutes for the survivors and 201 minutes for those that did not survive. P was greater than 0.05 for the difference in mean ischemic time for all survival intervals analyzed. Chi square analysis for the difference in survival at 3 months, 1 year, and 10 years for mean ischemic time categories of <2 hours, 2-4 hours, and >4 hours also did not show significance. Similarly, patients that survived 3 months post transplant had a mean procurement distance of 652 km whilst those that did not had a mean procurement distance of 586 km. After 1-year post transplant, the mean procurement distance was 643 km for the survivors and 631 km for those that did not survive. And after 10-year post transplant, the mean procurement distance was 667 km for the survivors and 621 km for those that did not survive. P was greater than 0.05 for the difference in mean procurement distance for all survival intervals analyzed. Chi square analysis for the difference in survival at 3 months, 1 year, and 10 years for mean procurement distance categories of <500 km, 500-1000 km, and >1000 km also did not show significance.
Conclusions: There were no significant difference in short, medium, and long-term survival outcomes with regards to ischemic time and transport distance. Further multi-centered and multi-geographical studies are needed to determine if there is a benefit to restricting donor catchment area to improve transport time.
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