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Preoperative and intraoperative risk factors affecting mortality after heart transplantation: a single-center experience [Anatol J Cardiol]
Anatol J Cardiol. 2011; 11(2): 119-124 | DOI: 10.5152/akd.2011.030  

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

Hasan Güngör1, Mehmet Fatih Ayık2, Sanem Nalbantgil3, Serkan Ertugay2, Çağatay Engin2, Tahir Yağdı4, Mehdi Zoghi5, Mustafa Özbaran6
1Clinic of Cardiology, Aydın Medline Hospital, Aydın-Turkey
2Ege Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, İzmir, Türkiye
3Ege Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
4Ege Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Anabilim Dalı, Bornova, İzmir, Türkiye
5Ege Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, İzmir, Türkiye
6Ege Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İzmir-Türkiye

Objective: 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% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 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.

Keywords: Heart transplantation, logistic regression analysis, mortality, risk factors, survival analysis

Hasan Güngör, Mehmet Fatih Ayık, Sanem Nalbantgil, Serkan Ertugay, Çağatay Engin, Tahir Yağdı, Mehdi Zoghi, Mustafa Özbaran. Preoperative and intraoperative risk factors affecting mortality after heart transplantation: a single-center experience. Anatol J Cardiol. 2011; 11(2): 119-124

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