Preoperative and intraoperative risk factors affecting mortality after heart transplantation: a single-center experience

WOS: 000288827900006PubMed ID: 21285017Objective: We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. Methods: Data of 123 patients (mean age 40.6 +/- 14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1 +/- 14.6,58 male) and 50 patients who died (Group 2, mean age 42.6 +/- 12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. Results: Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7 +/- 63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3 +/- 27.7 vs 126.9 +/- 42.1 min, p=0.05), pre-operative creatinine clearance (81.0 +/- 31.5 vs 67.2 +/- 33.0 ml/min, p=0.02), urea (45.2 +/- 18.6 vs 57.8 +/- 35.2 mg/dl, p=0.02), and creatinine (1.01 +/- 0.25 vs 1.17 +/- 0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21 +/- 5.16 vs 12.50 +/- 8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% Cl 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% Cl 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% Cl 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% Cl 0.992 1.249, p=0.045) were the independent predictors of mortality. Conclusion: Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation. (Anadolu Kardiyol Derg 2011; 11: 119-24