Monday July 02, 2018 from 09:45 to 11:15
Mechanical Circulatory Support Before And After Heart Transplantation: Impact On Survival
Giuseppe Raffa1, Giuseppe Romano1, Gabriele Di Gesaro1, Francesco Clemenza1, Michele Pilato1, Sergio Sciacca1.
1Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
Objective: To investigate the impact on survival of pre and post heart transplant (HT) use of mechanical circulatory support (MCS).
Methods: Data were collected retrospectively. ECMO was the MCS used to treat severe early graft failure (EGF). Log-rank test was used to compare Kaplan-Meier survival curves. A p-value <0.05 was considered statistically significant.
Results: 147 HT were done from 2004 to October 2016. The average male and female recipient’s age was 50±13 years and 47±14 years, respectively. Percentage of use of MCS and IABP to bridge patients to HT were 16% and 7%, respectively. MCS included: 8 HeartWare LVAD (5.4%), 6 ECMO (4.1%), 6 Levitronix BiVAD (4.1%), 2 Thoratec LVAD (1.4%) and 2 Levitronix LVAD (1.4%). Hospital mortality was 14.3% (21pt). 1-year survival was 82% and 5-year survival was 75%. Overall pre-transplant MCS was not correlated to worse post-transplant prognosis, p=0.822. Left sided MCS showed a worse survival compared to the no-MCS group (p=0.045) and to the ECMO and BiVAD (p=0.02). Severe primary EGF strongly impact the early mortality after heart transplantation (p<0.001). Excluding the 90 day mortality, the survival between patients with EGF and those without is similar (p=0.874).The risk of mortality increased almost 2 fold according each hour of ischemic time [OR=1.7, 95% IC, 1.1-2.7, p=0.017].
Conclusions: ECMO because of severe EGF remains associated with worse post-transplant outcomes however, patients discharged after severe EGF, showed a long term survival comparable to those without EGF. A LVAD before HT seems to affect the hospital mortality.