Ten-year follow-up of critically ill patients undergoing heart transplantation

Abstract

Background: The long-term result following heart transplantation appears very good despite complications of coronary atherosclerosis and cancer. Critically ill patients supported with mechanical devices remain a growing and difficult group in which long-term results need to be defined. The objective of this study was to review the 10-year follow-up of critically ill patients who underwent heart transplantation after support with mechanical devices. Methods We retrospectively analyzed all patients who underwent heart transplantation from 1986 to 1999 at the Montreal Heart Institute. Results Twenty-two patients (22/199, 11%) underwent heart transplantation after support with intra-aortic balloon pumps ( n = 17) and total artificial hearts ( n = 5). One hundred seventy-seven patients (177/199, 89%) underwent heart transplantation without pre-operative mechanical assistance. Patients with pre-operative mechanical assistance were younger (41 ± 12 vs 48 ± 10 years old, p = 0.002), underwent a shorter waiting time to transplantation (2 ± 2 vs 19 ± 27 weeks, p = 0.004), and donor hearts had longer ischemic time (166 ± 63 vs 137 ± 49 minutes, p = 0.002) compared with patients without pre-operative mechanical assistance. One-month, 1-, 5-, and 10-year survival averaged 86% ± 7%, 67% ± 10%, 67% ± 10%, and 59% ± 12%, respectively, in patients with pre-operative mechanical assistance compared with 95% ± 2%, 88% ± 2%, 81% ± 3%, and 74% ± 4%, respectively, in patients without assistance, a significant difference ( p = 0.04) that is mainly related to higher operative mortality in the former group. Although, we found no difference between the 2 groups in the 10-year freedom rate from acute rejection, infection, cancer, and coronary atherosclerosis, sepsis was the cause of 4 early deaths among patients with pre-operative mechanical assistance. Conclusion Early and long-term survival was significantly decreased in critically ill patients with pre-operative mechanical assistance compared with other patients without pre-operative assistance. Sepsis is a dominant threat among patients who underwent heart transplantation with pre-operative mechanical assistance, and the lower survival is due mainly to the increased early mortality.