Orthotopic Heart Transplantation in Different Categories of Patients. Does It Matter?

Abstract

PurposeThe number of patients undergoing heart transplantation (HT) after a previous sternotomy or LVAD support is increasing. We sought to identify differences in HT outcomes among different preoperative categories of patients.MethodsWe reviewed records of 266 consecutive patients who underwent HT from 10/31/12 to 10/15/20. Patients who had heart and kidney transplantation, re-transplantation, or had total artificial heart were excluded. We compared HT outcomes among 4 groups: patients undergoing HT without previous sternotomy - virgin chest group; redo sternotomy group; patients who had LVAD as a bridge to transplant (BTT); and patients initially deemed as HT ineligible who had LVAD as destination therapy but converted to BTT candidacy (BTTC).ResultsIn 266 patients, 30 day and 1-year HT survival were 97% and 94.7%, respectively. Patients in redo sternotomy group were older in comparison to other groups (P =.015) and had more men (P=.005). Patients in BTTC group had a higher body mass index (29.5±4 kg/m2) in comparison to other groups (27±5 kg/m2), P <.01. Time on LVAD support was comparable between BTT and BTTC groups, 724±576 days vs 716±529 days, respectively. In comparison to virgin chest group, ICU length of stay (LOS) and post HT LOS were longer in other groups (P <0.03). However, posttransplant 30 day and 1-year survivals were comparable. There was a trend to worse survival in the BTTC group in comparison to virgin chest group, but did not reach a significant difference (P =.104).ConclusionPosttransplant survival in BTT patients supported on average 2 years is comparable to survival with conventional virgin chest HT. Although it did not reach statistical significance, lower survival of BTTC patients necessitates consideration of risk factors. Among 4 patients who died in this group, 3 had diabetes mellitus and 2 had prolonged driveline infection. Operative complexity in redo sternotomy patients may affect HT survival as 3 patients died within 30 days and a fourth one died 37 days after procedure. The number of patients undergoing heart transplantation (HT) after a previous sternotomy or LVAD support is increasing. We sought to identify differences in HT outcomes among different preoperative categories of patients. We reviewed records of 266 consecutive patients who underwent HT from 10/31/12 to 10/15/20. Patients who had heart and kidney transplantation, re-transplantation, or had total artificial heart were excluded. We compared HT outcomes among 4 groups: patients undergoing HT without previous sternotomy - virgin chest group; redo sternotomy group; patients who had LVAD as a bridge to transplant (BTT); and patients initially deemed as HT ineligible who had LVAD as destination therapy but converted to BTT candidacy (BTTC). In 266 patients, 30 day and 1-year HT survival were 97% and 94.7%, respectively. Patients in redo sternotomy group were older in comparison to other groups (P =.015) and had more men (P=.005). Patients in BTTC group had a higher body mass index (29.5±4 kg/m2) in comparison to other groups (27±5 kg/m2), P <.01. Time on LVAD support was comparable between BTT and BTTC groups, 724±576 days vs 716±529 days, respectively. In comparison to virgin chest group, ICU length of stay (LOS) and post HT LOS were longer in other groups (P <0.03). However, posttransplant 30 day and 1-year survivals were comparable. There was a trend to worse survival in the BTTC group in comparison to virgin chest group, but did not reach a significant difference (P =.104). Posttransplant survival in BTT patients supported on average 2 years is comparable to survival with conventional virgin chest HT. Although it did not reach statistical significance, lower survival of BTTC patients necessitates consideration of risk factors. Among 4 patients who died in this group, 3 had diabetes mellitus and 2 had prolonged driveline infection. Operative complexity in redo sternotomy patients may affect HT survival as 3 patients died within 30 days and a fourth one died 37 days after procedure.