Intraoperative Goal-Directed Perfusion Improves Outcomes in Left Ventricular Assist Device Explant Heart Transplantation.

Authors

Chen Chia Wang, Mark Petrovic, Awab Ahmad, Walter Navid, Christian Eidson, Kevin McGann, John Trahanas, Swaroop Bommareddi, Tarek Absi, Eric Quintana, Aniket Rali, Kelly Schlendorf, Matthew Bacchetta, Ashish Shah, Brian Lima, Aaron M Williams

Published in

ASAIO journal (American Society for Artificial Internal Organs : 1992). Sep 28, 2026. Epub Sep 28, 2026.

Abstract

Left ventricular assist device (LVAD) explant heart transplantation represents a metabolically vulnerable population with an increased risk for renal failure and mortality. Oxygen extraction ratio (O2ER), which integrates oxygen delivery and tissue oxygen demand, may provide a physiologic marker of cumulative metabolic stress during cardiopulmonary bypass (CPB). Adult LVAD-explant heart transplant recipients at a single center from October 2021 to June 2025 were analyzed using continuous perfusion data captured during CPB. Oxygen extraction ratio was calculated continuously, and cumulative oxygen extraction burden was quantified as the area above an O2ER threshold of 0.20. Patients were stratified by median O2ER burden. Among 110 patients, a higher intraoperative O2ER burden was associated with increased postoperative renal replacement therapy (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.35-12.83) and increased 2-year mortality (hazard ratio [HR], 7.61; 95% CI, 1.49-38.73) after inverse probability weighting adjustment. A higher O2ER burden was also associated with a lower immediate postoperative cardiac index and increased vasoactive inotrope requirements. Donor hypertension, recipient diabetes, static storage modality, and a lower intraoperative oxygen delivery index were associated with an increased O2ER burden. These findings suggest that cumulative oxygen extraction during CPB reflects intraoperative metabolic stress and may represent a physiologically integrated perfusion target in LVAD-explant heart transplantation.

PMID:
42804765
Bibliographic data and abstract were imported from PubMed on 29 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.