Isolated Coronary Artery Bypass Grafting or Valve Surgery is Associated with Increased Mortality Following Heart Transplantation under the New Donor Heart Allocation System

Abstract

<h3>Purpose</h3> Literature indicates that history of cardiac surgery prior to HTx portends poor post-HTx survival, although the impact of coronary artery bypass grafting (CABG) or valve surgery remains unknown. We sought to determine the effect of these two procedures on survival following HTx under the new allocation system. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was queried for adults who underwent first time, single-organ HTx between October 2018 and March 2020. Recipients who had a prior isolated CABG or isolated open-heart valve procedure were included in the I-CABG/valve group. Recipients with history of 1) no cardiac surgery, 2) other cardiac surgery, and 3) concomitant CABG and valve surgery were included in the non-I-CABG/valve group. 180-day survival following HTx was analyzed between groups using the Kaplan-Meier method and Cox proportional hazards analysis. <h3>Results</h3> Of the 2,688 recipients included in this study, 313 (11.6%) were included in the I-CABG/valve group. 1,666 (62.0%) had no history of cardiac surgery prior to HTx. Those in the I-CABG/valve group were significantly older (58.3±9.7 vs. 52.3±13.2, p<0.01) and were more likely to have an ischemic heart failure etiology (52.4 vs. 21.0%, <i>p</i><0.01), although gender and body mass index were similar. Hazard of 180-day post-HTx mortality was significantly higher in the I-CABG/valve group after adjustment for age, BMI, gender, heart failure etiology, region, and inotrope use (11.3% vs. 6.3%, adjusted hazard ratio 1.71, 95% CI 1.16-2.52, log-rank <i>p</i><0.01). <h3>Conclusion</h3> Under the new allocation system, recipients with a history of isolated CABG/valve surgery are at greater risk of 180-day post-HTx mortality. These recipients may require careful considerations prior to undergoing HTx.