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DOI: 10.1055/s-0029-1246626
Impact of high urgency listing and VAD implantation on post-heart transplant survival
Objectives: The clinical preoperative status mainly predicts the outcome post-transplant. Recipients with a limited hemodynamic status or with complications on VAD-support might receive the urgency-status from Eurotransplant. We analyze the impact of urgency-listing and VAD-support on the outcome post-transplant.
Methods: 409 heart transplants were performed between 4/1990 and 8/2009. We analyzed four groups: transplant on urgency-list (U-group); on urgency-list and VAD-support (U-VAD-group); on normal waiting-list without VAD-support (N-group) and with VAD-support (N-VAD-group).
Results: Almost one-third of all transplants were performed with urgency-listing and with previous VAD-support (Table). Patients with a VAD were significant younger. The overall waiting-time for cardiac transplant was non-significant different between the groups. However, waiting-time on the urgency-list was significantly longer in VAD supported patients. Mortality post-transplant was the highest in patients with previous VAD-support, despite urgency-listing.
Conclusion: Early outcome post-transplant in urgency patients without VAD support is comparable to the outcome from the elective waiting list. Previous VAD bridging has a negative impact on survival post-transplant in both the elective and the urgency group.
|
Values |
N group |
N-VAD group |
U group |
U-VAD group |
p value |
|
Total |
255 (62.4%) |
43 (10.5%) |
40 (9.9%) |
71 (17.4%) |
|
|
Age, years |
52±14 |
40±15* |
49±18 |
39±16* |
.000 (*vs N and U group) |
|
Gender, male |
205 (80.4%) |
37 (86%) |
27 (68%) |
56 (79%) |
.187 |
|
Overall waiting time, days |
222±293 |
209±167 |
161±186 |
278±208 |
.150 |
|
Waiting time (urgency list), days |
29±35 |
49±57 |
.041 |
||
|
Previous cardiac operation |
67 (26.3%) |
15 (38%) |
.001 |
||
|
30-day mortality |
38 (14.9%) |
10 (23.3%) |
1 (2.5%) |
16 (22.5%) |
.022 |