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Donor and recipient characteristics, as well as donor-recipient matching, affect clinical outcomes after heart transplantation (HTx). This study aimed to clarify how donor and recipient characteristics affect the clinical course after HTx. The medical records of all the patients who underwent HTx at the National Cerebral and Cardiovascular Center from 1999 to 2014 were retrospectively reviewed. Sixty-one patients (48 males) underwent HTx. Six recipients (9.8 %) developed primary graft dysfunction (PGD) determined by criteria recently established at a consensus conference. Development of PGD was associated with high-dose inotropic support for the donor heart and a history of stroke in the recipient ( p = 0.04 and p = 0.002, respectively). Recipients with PGD had higher right atrial pressure (RAP) and lower cardiac output (CO) compared with those without PGD at 6 months after HTx (RAP, 6.8 ± 3.6 vs. 2.8 ± 2.2 mmHg, p < 0.001; CO, 4.6 ± 0.8 l vs. 5.8 ± 1.2 l/min, p = 0.02). With respect to survival, patients with PGD had a 5-year survival rate equivalent to those without PGD (83.3 vs. 93.3 %, p = 0.23). High-dose inotropic support for the donor heart and a history of stroke in the recipient are significant predictive factors for the development of PGD. However, recipients with PGD demonstrate mid-term survival comparable to those without PGD. [ABSTRACT FROM AUTHOR]

Purpose: We reviewed our clinical experiences with cardiovascular homografts harvested and preserved at our institutional tissue banks. Methods: Since our bank was first established in Japan in 1990, 74 patients have undergone various surgical procedures using homografts. We classified them into five groups according to the procedure: Group I, subcoronary implantation of a homograft aortic valve; Group II, homograft aortic root replacement for active native or prosthetic endocarditis; Group III, homograft aortic replacement for mycotic aortic aneurysms or infected grafts; Group IV, pulmonary homografts in the Ross operation; and Group V, pulmonary homograft conduits for complex congenital heart diseases. Results: The 9- to 10-year survival rates were good and acceptable, respectively, for the patients in all five groups. The infection recurrence rate was low (8%). Cardiac event-free rates, including deaths, were 0.57 in Group I, 0.58 Group in II, 0.75 in Group III, 0.81 in Group IV, and 0.69 in Group V operations. The rates of structural homograft deterioration suggest that homografts deteriorate more rapidly after subcoronary implantation than aortic root replacements ( P = 0.058). Conclusions: Subcoronary implantation should probably be abandoned for routine aortic valve replacement, but the continued use of homografts will provide valuable alternatives for patients with active infectious cardiovascular diseases. For the Ross operation, pulmonary valve homografts showed good durability. [ABSTRACT FROM AUTHOR]