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This is a single center retrospective/prospective observational study with additional procedures meant to evaluate molecular mechanisms underlying injury in donor's heart.
The research project will focus on Metabolomics by NMR and LC-MS and ultrastructural analysis using electron microscopy of endomyocardial biopsies (EMB).In our clinical protocol of heart transplantation, myocardial biopsy samples are routinely provided at intraoperative and postoperative time.
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| Measure | Description | Time Frame |
|---|---|---|
| Biventricular failure: left ventricular failure (LV EF <40%) and right ventricular failure (TAPSE <16% and/or FAC < 35% and/or S' wave velocity < 10 cm/sec) within 24 hours post transplantation | Within 24 hours post transplantation |
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular dysfunction (longitudinal global strain (LGS) < -14% at 1 month and <-17% at 6 and 12 months and/or FEvsx <50%) at 1, 6, 12 months after transplant (in absence of rejection) | At 1, 6, 12 months after transplant | |
| Left ventricular failure (LV EF <40%) within 24 hours post transplantation |
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Inclusion Criteria:
- Informed Consent available
Exclusion Criteria:
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Potentially all patients undergoing heart transplant at the Cardiac Surgery - Fondazione IRCCS Policlinico San Matteo, Pavia until 31-12-2024
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fondazione IRCCS Policlinico San Matteo | Pavia | Pavia | Italy |
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| Within 24 hours post transplantation |
| Right ventricular failure (TAPSE <16% and/or FAC < 35% and/or S' wave velocity < 10 cm/sec) within 24 hours post transplantation | Within 24 hours post transplantation |
| Hemodynamic: Cardiac Index < 2 L/min/mq, wedge pressure >20 mmHg, right atrial pressure (RAP > 15 mmHg) within 24 hours post transplantation and at 1, 6, 12 months after transplant (in absence of rejection) | At 1, 6, 12 months after transplant |
| Death for graft failure within 24 hours post transplantation | Within 24 hours post transplantation |
| ECMO within 24 hours of transplant for ventricular failure | Within 24 hours of transplant |
| IABP within 24 hours of transplant for ventricular failure | Within 24 hours of transplant |
| Echocardiographic parameters: E/A>>1; DT<150 msec; E/e'>15, atrial strain at 1, 6, 12 months after transplant (in absence of rejection) | At 1, 6, 12 months after transplant |
| Death at 1, 6, 12 months after transplant (in absence of rejection | At 1, 6, 12 months after transplant |
| Trend of cardiac biomarker (BNP), trend of TNIhs, angiotensinogen, ADIPOQ, HGFAC, IGFBP3, other markers of ischaemia | At first and third week |