Determinants of Short-Term Survival After Heart Transplantation in Patients Bridged to Transplant With Left Ventricular Assist Device.

BACKGROUND

The bridge to heart transplantation has been the subject of intense debate. This study aimed to determine the factors affecting early survival after bridge to heart transplantation.

METHODS

Between 2011 and 2019, patients who underwent a bridge to heart transplantation in a single center were retrospectively scanned. Demographics, complications of left ventricular assist device (LVAD), cardiopulmonary bypass (CPB), and cross-clamp duration, use of blood products, length of ventricular assist device (VAD) support, post-transplant hospital stay, post-transplant complications, and in-hospital mortality rates were recorded.

RESULTS

Patients (n = 60) were divided into 2 groups; patients with 30-day mortality (group 1, n = 10) and those with survival longer than 30 days (group 2, n = 50). The patients in group 1 were found to be older (P = .009), supported for a longer duration (P = .027), have higher International Normalized Ratio (INR) levels (P = .025), and have device-specific infection more commonly (P = .003). Cardiac ischemia (P = .013) and CPB (P = .006) durations were longer in group 1. Use of blood products and nitric oxide (NO) was more frequent in group 1 (P < .05). Post-transplantation complications (stroke, sepsis, kidney failure, arrhythmia, need for intra-aortic balloon pump [IABP], and short-term mechanical circulatory support [MCS]) were significantly more common in group 1 patients (P < .05). Blood products (0.920 for red blood cells, 0.901 for fresh frozen plasma, and 0.885 for platelets), postoperative high creatinine (0.817) and lactate (0.715), and device-specific infection (0.686) had the highest area under the curve values in the receiver operating characteristic (ROC).

CONCLUSIONS

Bridge to transplantation has its own challenges of being a reoperation under high INR levels. Recurrent infection attacks and an inflammatory state may be limiting the healing process. Device-specific infection may be a major reason for early mortality whereas it is also a major indication for urging heart transplantation.