Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2014.55.553
Pretransplant and perioperative predictors of early heart transplantation outcomes
Hrvoje Gašparović
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Stjepan Ivanković
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Jana Ljubas Maček
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
Filip Matovinović
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Mislav Nedić
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Lucija Svetina
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Maja Čikes
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
Boško Skorić
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
Željko Baričević
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
Višnja Ivančan
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Bojan Biočina
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb Croatia
Davor Miličić
; Department of Cardiac Surgery Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
Sažetak
Aim To identify predictors of 3-month mortality after heart transplantation
in a Croatian academic center.
Methods A retrospective review of institutional database identified
117 heart transplantations from January 2008 to July 2014. Two children
<14 years were excluded from the study. The remaining 115
patients were dichotomized into survivors and non-survivors adjudicated
at 3-months postoperatively, and their demographic, clinical,
and longitudinal hemodynamic data were analyzed.
Results 3-month survival after heart transplantation was 86%. Nonsurvivors
were older (59 ± 8 vs 50 ± 14 years, P = 0.009), more likely
to have previous cardiac surgery (44% vs 19%; odds ratio [OR] 3.28,
95% confidence interval [CI] 1.08-9.90; P = 0.029), lower body mass
index (BMI) (25 ± 4 vs 28 ± 2 kg/m2, P = 0.001), and be diabetics (44%
vs 23%; OR 2.57, 95% CI 0.86-7.66; P = 0.083). Creatinine clearance
was marginally superior among survivors (59 ± 19 vs 48 ± 20 mL/
min, P = 0.059). Donor age and sex did not affect outcomes. Nonsurvivors
were more likely to have had ischemic cardiomyopathy
(69% vs 32%, P = 0.010). Postoperative utilization of epinephrine as a
second line inotropic agent was a strong predictor of mortality (63%
vs 7%; OR 21.91; 95% CI 6.15-78.06; P < 0.001). Serum lactate concentrations
were consistently higher among non-survivors, with the
difference being most pronounced 2 hours after cardiopulmonary
bypass (9.8 ± 3.5 vs 5.2 ± 3.2 mmol/L, P < 0.001). The donor hearts
exhibited inferior early hemodynamics in non-survivors (cardiac index
3.0 ± 1.0 vs 4.0 ± 1.1 L/min/m2, P = 0.001), stroke volume (49 ± 24
vs 59 ± 19 mL, P = 0.063), and left and right ventricular stroke work
indices (18 ± 8 vs 30 ± 11 g/beat/m2, P < 0.001 and 5 ± 3 vs 7 ± 4 g/
beat/m2, P = 0.060, respectively). Non-survivors were more likely to
require postoperative re-sternotomy (50% vs 12%; OR 7.25, 95% CI
2.29-22.92; P < 0.001), renal replacement therapy (RRT) (69% vs 9%;
OR 22.00, 95% CI 6.24-77.54; P < 0.001), and mechanical circulatory
assistance (MCS) (44% vs 5%; OR 14.62, 95% CI 3.84-55.62; P < 0.001).
Binary logistic regression revealed recipient age (P = 0.024), serum
lactates 2 hours after CPB (P = 0.007), and epinephrine use on postoperative
day 1 (P = 0.007) to be independently associated with
3-month mortality.
Conclusion Pretransplant predictors of adverse outcome after
heart transplantation were recipient age, lower BMI, ischemic cardiomyopathy,
reoperation and diabetes. Postoperative predictors
of mortality were inferior donor heart hemodynamics, epinephrine
use, and serum lactate concentrations. Non-survivors were more
likely to require re-sternotomy, MCS, and RRT.
Ključne riječi
Hrčak ID:
139283
URI
Datum izdavanja:
15.12.2014.
Posjeta: 997 *