Primary heart dysfunction is greater with combined heart and lung compared with isolated heart procurement

Eilon Ram*, Jacob Lavee, Yigal Kassif, Yury Peysakhovich, Leonid Sternik, Amit Segev, Jignesh Patel, Yael Peled

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Combined heart and lungs (CHL) procurement differs from isolated heart (IH) procurement in several aspects, including lung recruitment, cannulation, and preservation requirements. We aimed to investigate whether CHL versus IH procurement contributes to the development of primary graft dysfunction (PGD) after heart transplantation (HT). Methods: Between 1999 and 2019, we assessed 175 patients undergoing HT at a single center. Patients were divided into IH (n = 61) or CHL (n = 114) procurement groups. End points included PGD (defined according to the International Society for Heart and Lung Transplantation consensus statement) and long-term survival. Results: The incidence of PGD was significantly greater in CHL recipients compared with IH recipients (53.5% vs 16.4%, P < .001). Multivariable analysis showed that CHL procurement was independently associated with a significant 4.6-fold increased risk for PGD (95% confidence interval, 2.1-11, P < .001). Univariable and multivariable analyses showed that the overall survival was not significantly affected by the procurement group (log-rank P = .150, hazard ratio, 1.13; 95% confidence interval, 0.68-1.88, P = .646). The simultaneous procurement of abdominal organs was not associated with an increased risk of PGD in HT recipients. These results remained consistent in a propensity-matched analysis. Conclusions: Combined procurement of heart and lungs is independently associated with an increased risk of PGD. Further prospective studies are needed to validate this hypothesis-generating study.

Original languageEnglish
Pages (from-to)186-195.e4
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number1
StatePublished - Jan 2023


  • combined heart and lungs
  • heart transplantation
  • lung procurement
  • multiple organ procurement
  • primary graft dysfunction


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