Donor heart coronary artery bypass grafting

Objective: to evaluate the initial experience of performing simultaneous heart transplant (HT) with coronary artery bypass grafting (CABG) at Almazov National Medical Research Centre in St. Petersburg.

Materials and methods. Outcomes of 196 HT performed between January 1, 2016, and January 1, 2025, were analyzed. Patients were divided into two groups: 16 recipients who underwent combined HT + CABG (Group 1) and 180 recipients who underwent standard HT (Group 2). The groups were compared using the following parameters: duration of surgery, graft ischemic time, duration of cardiopulmonary bypass (CPB), duration of inotropic therapy, length of stay in the intensive care unit (ICU), 30-day mortality, and one-year survival.

Results. The operative time was longer in Group 1, at 312 (286–415); 2020; 1130 min, compared with Group 2, at 268 (225–320); 150; 2150 min (p = 0.007). Group 1 also demonstrated a significant increase in graft ischemic time and CPB duration compared to group 2. Median graft ischemic time in Group 1 was 156 (146–180); 120, 240 min, versus 140 (120–160); 40, 240 min in Group 2 (p = 0.021). CPB duration was 159 (133–180); 101, 214 min in Group 1 and 128 (101–162); 71–350 min in Group 2 (p = 0.015). Despite the more complex nature of the intervention in Group 1, no statistically significant differences were observed between the groups in the duration of inotropic therapy or length of stay in the ICU. Although the 30-day mortality rate was higher in Group 1 than in Group 2 (18.7% vs. 7.8%), this difference did not reach statistical significance (p = 0.136). One-year survival rates were comparable between the two groups.

Conclusion. Simultaneous HT and CABG procedures are associated with longer operative time, prolonged graft ischemia, and longer CPB duration compared with standard HT. However, no differences were observed in the duration of inotropic therapy or early postoperative period. Combined HT and CABG procedures are technically feasible, with 30-day mortality and one-year survival rates comparable to those of standard HT. The use of donor hearts with underlying coronary artery pathology may expand donor selection criteria and increase the number of HT procedures performed.

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