Influence of the Type of Circulatory/Ventricular Assistance in the Primary Graft Failure and Heart Transplantation Mortality

Abstract

Background and Objective: 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 hospital mortality according to the type and duration of care. 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 (table 1). 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 deads (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 12.5% 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.