0056: Results of cardiac transplantation according access modalities. Single centre eight years experience

Abstract

We evaluated the results of cardiac transplantation according access modalities. Between 2005 and 2012, 562 patients underwent isolated cardiac transplantation, divided into five groups: patients under left ventricular assist device (group LVAD, n=27, 5%), patients under bi-ventricular assist device (group Bi-VAD, n=25, 4%), patients transplanted under ECMO (group ECMO n=90, 16%), patients transplanted according the SuperUrgence1 waiting list without ECMO (group SU1 NOECMO n=131, 23%), patients transplanted on the standard waiting list (group Liste, n=289, 53%). A comparison between the periods 2005/2008 and 2009/2012 was made for the groups LVAD+Bi-VAD, ECMO, SU NOECMO and Liste. The occurrence of primary graft dysfunction was: 26% (group LVAD), 44% (group Bi-VAD), 42% (group ECMO), 21% (group SU1 NOECMO), 26% (group Liste). The period analysis showed no change in primary graft dysfunction over the time: 33% vs 36% (group LVAD+ Bi-VAD), 50% vs. 35% (group ECMO), 23% vs. 20% (group SU1 NOECMO), 28% vs. 24% (group Liste). One-year mortality was: 15% (group LVAD), 20% (group Bi-VAD), 31% (group ECMO), 23% (group SU1 NOECMO), 28% (group Liste). Time analysis showed a 1-year mortality decrease during the 2009/ 2012 period: 10% vs 27% (group LVAD+ Bi-VAD), 29% vs. 33% (group ECMO), 17% vs. 30% (group SU1 NOECMO), 20% vs. 34% (group Liste). Three-year survival was: 81% (group LVAD), 71% (group Bi-VAD), 64% (group ECMO), 74% (group SU1 NOECMO), 66% (group Liste). Actually, stable patients on the standard waiting lists represent only half the transplantation activity. Patients transplanted under longterm circulatory support, especially LVAD, have the best results. Superurgence1 waiting list patients have good results if they not require pre-transplant ECMO support. Need for a pretransplant ECMO is associated with a higher operative mortality. Outcomes improved over the time for every group of patients.