Severe Postoperative Bleeding after Heart Transplantation.

BACKGROUND

Postoperative bleeding is frequent in cardiac surgery, but its incidence, risk factors, and consequences remain largely unknown after heart transplantation. The main objective of this study was to describe the incidence of severe bleeding complications after adult heart transplantation.

METHODS

The authors conducted an observational study including all adult patients who received a heart transplant between 2015 and 2022 in two French referral centers. The primary endpoint was the incidence of severe bleeding complications defined by a Universal Definition of Perioperative Bleeding score of 3 or greater. Multivariable logistic regression was used to identify variables associated with the incidence of severe postoperative bleeding. The impact of severe postoperative bleeding on 1-yr mortality was evaluated using a multivariable Cox regression model.

RESULTS

Among the 446 patients included, 112 (25%) developed severe bleeding. In multivariable analysis, long-term mechanical cardiac support (adjusted odds ratio [adjOR; 95% CI], 2.21 [1.01 to 4.88]), preoperative hemoglobin (adjOR, 0.85 [0.76 to 0.95]) and the duration of cardiopulmonary bypass (per 10-min increase; adjOR, 1.08 [1.03 to 1.15]) were associated with severe bleeding. Severe postoperative bleeding was associated with an increased mortality at 1 yr (35% vs. 13%; P < 0.001), with an adjusted hazard ratio of 1.91 (95% CI, 1.18 to 3.09; P = 0.008).

CONCLUSIONS

This study reports a high incidence of severe hemorrhagic complications after heart transplantation, particularly in patients with mechanical circulatory support. Bleeding complications were associated with a significant increase in morbidity and mortality. Larger-scale studies are needed to identify and evaluate potential prevention strategies.