Author + information
- Pranav Kansara,
- Lawrence Czer,
- Jignesh Patel,
- James Mirocha,
- Michelle Kittleson,
- Mick De Robertis,
- Jaime Moriguchi,
- David Chang,
- Danny Ramzy,
- Robert Kass,
- Fardad Esmailian,
- Alfredo Trento and
- Jon Kobashigawa
Patients (pts) with history of prior cardiac surgery (PCS) may have poorer outcomes after heart transplant (Htx) from higher perioperative complications. The amount of risk from PCS has not been well estasblished. Therefore, we analyzed the UNOS database for 60 day morbidity & mortality after Htx for pts with & without PCS.
11,266 pts with 1st Htx between 1997 & 2011 were examined: First group (gp) without PCS (6005, 53.3%) & Redo gp with at least 1 PCS (5261, 46.7%). Multivariate cox model was used to identify predictors of mortality.
Survival was lower in Redo gp at 60 days (92.8 vs 96%; HR 1.83, 95% CI: 1.56-2.15; p < 0.0001). During 1st 60 days post Htx, Redo gp had more cardiac reoperations (12.3 vs 8.8%, p=0.0008), dialysis (8.9 vs 5.2%, p<0.0001), drug-treated infections (23.2 vs 19%, p=0.003) & stroke (2.5 vs 1.4%, p=0.0001). 60-day predictors of mortality: pre transplant bilirubin ≥3, creatinine ≥2, need for ventilation, mechanical circulatory support & dialysis for both gps; congenital & restrictive cardiomyopathy and age in Redo gp; ischemic & valvular cardimyopathy for first gp. Primary cause of death (cardiovascular, cerebrovascular, graft failure, hemorrhage, infection, multiorgan failure) was comparable between 2 gps at 60-days.
History of PCS is associated with increased morbidity & mortality in the first 60-days post Htx. This factor should be added to the risk profile of patient undergoing evaluation for heart transplant.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Challenges and Clinical Outcomes in Cardiac Transplantation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1309-310
- 2013 American College of Cardiology Foundation