Abstract
We hypothesised that cardiac power output index (CPOi) and its adjustment for the vasoactive-inotrope score (VIS) can predict the endpoint of severe early graft dysfunction (EGD) - defined as mechanical circulatory support (MCS) and/or 30-day mortality post- heart transplantation (HTx). Single-centre study of consecutive HTx from January 2014 to July 2019 (n=145). Failure to separate from cardiopulmonary bypass and direct conversion to MCS were excluded (n=19). Data on return to intensive care unit (ICU) (T0) and at 6 hours (T6) post-HTx were collected. VIS was calculated based on Davidson et al's formula. CPOi = (mean blood pressure-right atrial pressure) x cardiac index/451. VIS-CPOi is CPOI divided by square root of (VIS+1) x 100. 126 patients were included: 20 patients met the endpoint of MCS and/or death <30 days (19 patients had MCS after return to the ICU and 1 died without MCS). Baseline characteristics were comparable between patients with and without endpoint [Age 54 (45-60) vs 47 (35-56) years; donor:recipient predicted heart mass ratio 0.97 (0.92-1.11) vs 1.03 (0.96-1.13); ischemic time 182 (161-208) vs 177 (130-207) minutes, all p>0.05], except for higher number of resternotomy (35% vs 12%, p=0.011) and CPB time (208 (186-279) vs 176 (141-223) minutes, p=0.002). CPOi and VIS-CPOi were lower in patients with endpoint and dropped further from T0 and T6, unlike patients with no endpoint [FIGURE]. CPOi at T6 was significantly associated with MCS and/or death <30 days after adjusting for baseline differences (OR 0.37, 95% CI 0.22-0.62). The area under the receiver operating characteristic curve for CPOi were 0.87 and 0.91 at T0 and T6; and did not improve with adjustment for VIS. CPOi at T0 less than 0.34W/m2 and T6 less than 0.31W/m2 had sensitivity of 85 and 90% and specificity of 86% and 88%, respectively. CPOi less than 0.34 and 0.31W/m2 at T0 and T6 can identify patients with severe EGD. Adjustment for VIS did not improve discrimination.
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