Second-opinion stress tele-echocardiography for the Adonhers (aged donor heart rescue by stress echo) project

Background. To resolve the current shortage of donor hearts, we established the Adonhers protocol. An upward shift of the donor age cut-off limit (from the present 55 to 65 years) is acceptable if a stress echo screening on the candidate donor heart is normal. Aims. To verify feasibility of a "second opinion" of digitally transferred images of stress echo results to minimize technical variability in selection of aged donor hearts for heart transplant. Methods. The informatics infrastructure was created for a core lab reading with a second opinion from the stress echo lab. Starting January 2010, real older donor stress echos were sent via internet to the central core echo lab, for a second opinion before heart transplant. Results. Simulation protocol: n = 30 stress echo quad screen cine loops and reports were sent to the core echo lab; images were readable and the second opinion evaluation was feasible in all cases (100% feasibility). Transplant protocol: 19 older donor (age 54 ± 10 years, 13 male) stress echos were sent via internet to the central core echo lab. The second opinion was feasible in 16l19 cases (84% feasibility); one case had low-quality cineloops, two cases had incorrect quad screen image upload. Second opinion answer delay was 37 ± 48 min. Agreement between conventional and tele-echocardiographic interpretations was present in all 16 cases. Twelve hearts had normal stress echo response and 10 were successfully transplanted; 2 were not transplanted due to absence of recipient match. Four hearts had abnormal response and were dismissed. Conclusions. Second-Opinion Stress Tele-Echocardiography can effectively be performed in a network aimed at safely expanding the heart donor pool for heart transplant.