Favorable Short-Term Outcome of Transplanted Hearts Selected from Marginal Donors by Pharmacological Stress Echocardiography

Medium-term outcome of recipients of marginal donor hearts selected with new stress-echocardiographic techniques over standard criteria

“…According to a methodology previously described in detail, in this analysis we enrolled three different categories of potential marginal donors: 1) 97 patients enrolled in the Adonhers project [3,4,12], consisting of potential donors aged > 55 years, or < 55 years but with concomitant risk factors; 2) 6 subjects with resting wall motion abnormality undergoing pharmacological stress echo [5]; 3) 15 subjects with hemodynamic instability [13] Table 1. In all cases, LV wall motion score index (WMSI) was assessed and graded on a scale from 1 (normal) to 4 (dyskinetic) in each of the 17 segments at rest and following intervention (pharmacological stress or HT) [14,15].…”

“…In Europe every year a pool of ≈ 4500 unused hearts (500 in Italy) with permission granted for heart donation is estimated, from which additional transplants could be generated, with more confidence in their post-transplantation performance (Council of Europe, Donation and Transplantation, 2011) [1,2]. A stress echo-driven selection of donors has proven successful in three settings: 1) older donors with normal left ventricular (LV) resting function and negative stress echo [3,4]; 2) reversible resting left ventricular dysfunction acutely improving over minutes during stress [5]; 3) regional and global LV dysfunction slowly improving (over hours) during intensive hormonal treatment (HT) [6-11]. In all three conditions, encouraging results and short-term progress have been reported in preliminary proof of principle studies, but data on medium-term outcome have been conspicuously lacking to date.…”

Recent advances in stress echocardiography

“…However, recent findings indicate that stress echocardiography may occasionally provide a suitable alternative to invasive angiography. In a study of 'marginal' candidate donor hearts, all candidates with normal resting and pharmacological stress echocardiograms were free of significant CAD in either the first posttransplant angiogram or upon pathological examination in those donor hearts without a suitable recipient [42 ]. One-year survival in recipients of donor hearts screened with pharmacological stress echocardiography was 94% [42 ].…”

“…In a study of 'marginal' candidate donor hearts, all candidates with normal resting and pharmacological stress echocardiograms were free of significant CAD in either the first posttransplant angiogram or upon pathological examination in those donor hearts without a suitable recipient [42 ]. One-year survival in recipients of donor hearts screened with pharmacological stress echocardiography was 94% [42 ]. Although this study was small, the findings suggest an emerging role for stress echocardiography in the noninvasive assessment of potential donors for cardiac transplantation [43].…”

Ex Vivo Coronary Angiographic Evaluation of a Beating Donor Heart

“…2 In such marginal donors, invasive coronary angiography is the mainstay of investigation for coronary artery disease, although stress echocardiography has also been used successfully before organ harvesting. [3][4][5] Failure to perform pretransplant coronary angiographic screening of marginal donor populations may be associated with significant financial ramifications related to retrieval cost if the allograft is subsequently found to be unsuitable for transplant. However, preharvest coronary angiography may not always be feasible because of unavailability of cardiac catheterization at the donor institution and the need for urgent concurrent intra-abdominal organ procurement.…”