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Influence of the Type of circulatory/ventricular assistance in the Primary Graft Failure and Heart Transplantation Mortality

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World Journal of Cardiovascular Diseases 2019年第8期9卷 545-552页

作者： Raquel López-Vilella Ignacio J.Sánchez-Lázaro María Paz Fuset Cabanes Azucena Pajares Moncho Lucía Donate Bertolín Ricardo Gimeno Costa Ignacio Moreno Puigdollers Luis Martínez Dolz Iratxe Zarragoikoetxea Jauregui Salvador Torregrosa Puerta Luis Almenar Bonet Heart Failure and Transplant Unit Hospital Universitario y Politécnico La FeValenciaSpain Intensive Care Department Hospital Universitario y Politécnico La FeValenciaSpain Anesthesiology Department Hospital Universitario y Politécnico La FeValenciaSpain Cardiovascular Surgery Department Hospital Universitario y Politécnico La FeValenciaSpain

OBJECTIVES: In recent years, the percentage of heart transplantation (HT) with short/medium-term assistance devices has increased. This study aims at analyzing primary graft failure and in-hospital mortality according to the type of care. MATERIAL AND METHODS: From January 2013 to December?2017 all patients undergoing urgent HT with circulatory/ventricular assistance?were retrospectively and consecutively recruited. Combined transplants, retransplantations and pediatric transplants were excluded. The sample was divided in 10 groups according to the type of shot/medium term assistance devices. RESULTS: A total of 53 patients were recruited, 79% men, average age 49 ± 13 years. 26 patients (51%) had mechanical ventilation at the time of the HT. Primary graft failure occurred in 20 patients (38.5%), whilst it was more frequent in patients assisted with ECMO (8 patients in group 1 (45%) and 7 in group 2 (54%), p 0.5). 14 deaths (27%) were registered, whereas a higher mortality was observed in the group assisted with ECMO (6 patients in group 1 (34%) and 4 in group 2 (31%), p 0.6). Mortality was 17% in the group of non-urgent Levitronix. CONCLUSIONS: Despite not showing statistical significance due to the low number of patients in some subgroups, hospital?mortality was high in HT patients with circulatory assistance. A trend towards a higher incidence of primary graft failure and mortality in patients assisted with ECMO was observed. The direct implantation of a centrifugal pump as a bridge to urgent transplantation could identify a subgroup with a better prognosis.

关键词： Urgent Heart Transplantation short-medium term circulatory/ventricular assistance Primary Graft Failure

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