Abstract
<h3>Purpose</h3> A recent study from our research group investigated the impact of right ventricular mass (RVM) undersizing on postoperative outcomes. Here we aim to identify patients who are at high risk of poor postoperative outcomes when receiving a donor heart with undersized right ventricle. <h3>Methods</h3> We performed a retrospective analysis of adult heart transplant recipients undergoing primary transplantation using the UNOS database, from 1997 to 2017. Using previously validated equations we calculated estimated RVM for donors and recipients. Undersized RVM was determined as donor RVM less than recipient RVM. We performed multivariable Cox Proportional Hazards analysis to identify independent predictors of mortality in recipients of undersized RVM; RVAD prior to transplantation was forced into our model. <h3>Results</h3> Of the 38,740 transplants included in our study, 6,920 (17.9%) received donor hearts with undersized RVM. Multivariable Cox Proportional Hazards analysis demonstrated older age (HR 1.02, P<0.001), ECMO support (HR 2.94, P=0.007), inhaled NO support (HR 3.90, P=0.02), lower Karnofsky scores (HR 0.94, P=0.01), higher transpulmonary gradient (TPG)(HR 1.02, P=0.02), and higher creatinine (HR 1.45, P<0.001) to be independent predictors of mortality in recipients of undersized RVM. Pre-transplant RVAD was not associated with poorer outcomes. Patients were placed in a "high risk" group if they fell into the top 10% of these metrics (age > 66, Karnofsky score < 20%, TGP > 16, or Creatinine > 1.9). High risk patients had worse 1-year survival, while low-risk group had similar outcomes to non-RVM-undersized recipients (Figure 1). <h3>Conclusion</h3> Recipients older than 66, with Karnofsky score < 20%, having TPG greater than 16, or creatinine greater than 1.9, were at high risk for poor outcomes if receiving an undersized right ventricle. Close attention to these risk factors should be paid during donor heart selection.
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