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680 Prognostic Value of Supraventricular Rhythm Disturbances among Patients Late after Heart Transplantation – Single Center Experience
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The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
Results: All 3 groups had similar 5-year survival and freedom from TCAD. The 2 TR groups had similar dilated right atria and ventricles and reduced right ventricular ejection fraction (RVEF) as well as need for TV surgery (table). The low pressure TR group had significantly more flail TV leaflets (likely due to complications of heart biopsy).
Outcomes 5-Year Actuarial Survival 5-Year Freedom from CAV Pulmonary Artery Pressure (Mean PAP mmHg ⫾ SD) Dilated Right Atrium Dilated Right Ventricle Right Ventricular Dysfunction (Reduced RVEF) Flail Leaflets Need for tricuspid valve repair/ replacement
Control (No Early TR) (N⫽558)
High Pressure TR (N⫽27)
Low Pressure TR (N⫽9)
P-Value
82% 90% N/A
74% 89% 47 ⫾ 14
67% 100% 25 ⫾ 2
0.27 0.60 ⬍ 0.001
N/A N/A N/A
67% 48% 19%
44% 56% 33%
N/A N/A
0% 0%
56% 11%
0.25 0.71 0.37 ⬍ 0.001 0.08
Conclusions: Moderate-severe TR in the 1st yr after HTx does not appear to affect 5-year outcome but results in right ventricular enlargement and dysfunction. Flail tricuspid valves (most likely iatrogenic) occur rarely (⬍2%). Longer term follow-up may reveal increased need for tricuspid valve surgery. 680 Prognostic Value of Supraventricular Rhythm Disturbances among Patients Late after Heart Transplantation – Single Center Experience M. Sobieszczanska-Malek,1 T. Zielinski,1 M. Piotrowska,1 K. Komuda,1 J. Rozanski,2 J. Korewicki.1 1Heart Failure and Transplantology Department, Institute of Cardiology, Warsaw, Poland; 2Cardiosurgery Department, Institute of Cardiology, Warsaw, Poland. Purpose: Prognostic value of supraventricular rhythm disturbances, especially paroxysmal atrial fibrillation in pts after heart transplantation (HT) is not clearly defined. Aim of the study: Does supraventricular arrhythmia occurring later than 30 days after HT has a prognostic value. Methods and Materials: We analyzed medical records of 179 pts (146 men) after HT done between 2001- 2011. Mean age 45⫹/⫺15,5y. Mean observation time 4,5⫹/⫺3,3y. Episodes of supraventricular arrhythmia: atrial fibrillation (FA), supraventricular rhythm disturbances (SE_T) which occurred later than 30 days after HT not linked with acute cellular rejection or dyselectrolitemia were analysed. Survival was analyzed using Kaplan Meier curves and log rank test. Additionally we analysed the frequency of supraventricular arrhythmia in connection by type of surgical procedure (biatrial vs bicaval transplantation).
78 pts had bicaval HT. Supraventricular rhythm disturbances were recognised in 26 of 101 pts (26%) patients after biatrial type of HT and in 1 pts of 78 after bicaval transplantation(1%) p⬍ 0,0001. Conclusions: 1. Patients with supraventricular rhythm disturbances occurring at least 30 days after HT (not connected with dyselctrolitemia or acute rejection) have lower survival. 2. Bicaval type of transplantation is linked with lower risk of late supraventricular rhythm disturbances. 681 Severe Acute Kidney Injury Is the Most Powerful Predictor of Mortality after Heart Transplantation J. Shatrov,1 J. Sevastos,1,2 G. Jones,1,3 L.T. Lam,1 C. Hayward,4,5,6 A.M. Keogh,4,5,6 E. Kotlyar,4,6 P.S. Macdonald,4,5,6 P.M. Spratt.4 1 Medicine, University of Notre Dame, Darlinghurst, NSW, Australia; 2 Renal Medicine, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 3 Chemical Pathology, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 4Cardiopulmonary Transplant Unit, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 5Transplantation Research Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; 6 Medicine, University of New South Wales, Darlinghurst, NSW, Australia. Purpose: Pre-existing renal dysfunction is a well-recognised risk factor for increased mortality after heart transplantation. The aim of this study was to determine the relationship between peri-operative acute kidney injury (AKI) and subsequent mortality after heart transplantation (HTx). Methods and Materials: We retrospectively reviewed recipient, donor & procedural data (including peri-operative renal function, need for dialysis, length of stay (LOS) and survival outcomes of 194 consecutive HTx recipients who underwent HTx between August 2000 and June 2010. All patients were followed for at least 12 months. AKI was defined according to the RIFLE criteria established by Acute Dialysis Quality Initiative Workgroup. Results: Mean LOS post HTx was 27⫾26 days (median 18 days). Post HTx survival at 1 month, 1 and 5 years was 95⫾2%, 90⫾2 %, and 82⫾ 3 %, respectively. The number of patients with AKI according to the RIFLE classification was: no injury 80 (41%), risk 48 (25%), injured 37 (19%) and failure 29 (15%). Patients with failure (RIFLE-F) tended to be older and had higher rates of pre HTx hypertension (p⬍ 0.05) and pre HTx moderate/ severe chronic renal dysfunction (p ⫽ 0.02). Variables not associated with AKI included pre HTx diabetes, donor age, ischaemic time and primary graft failure which occurred in 32 recipients. Of 21 selected recipient, donor and procedural variables, only pre HTx eGFR and and AKI grade were significantly associated with LOS (p⬍0.005 and p⬍0.0001 respectively). On multivariate analysis, AKI grade (RIFLE-F) was the only independent variable associated with post HTx survival. One month, 1 and 5 year mortality for RIFLE-F patients was 18⫾7%, 29⫾9%, and 36⫾9%, versus 1⫾1%,5⫾2%, and 14⫾4% for HTx recipients with lesser grades of AKI (p,0.005). Conclusions: Severe AKI is uncommon after HTx but is associated with increased LOS and markedly increased mortality. Risk factors for AKI include older recipient age, pre HTx hypertension and pre HTx moderate/ severe chronic renal dysfunction. 682 Outcome of Extracorporeal Membrane Oxygenation as Short Term Mechanical Support Following Heart Transplantation: A Single Centre Experience S.R. Hosmane, R. Venkateswaran, J. Salaie, S. Williams, N. Yonan. Transplant Department, University Hospital of South Manchester, Manchester, United Kingdom.
Results: 16 pts had FA, 11 pts had SE_T and 152 had no rhythm disturbances. 41 pts died: 8 (50%) pts with FA, 6 (55%) with SE_T and 26 (17%) from all pts without rhythm disturbances. Patients with FA or SE_T had significantly poorer prognosis p⬍ 0,002. 101 pts have had biatrial HT and
Purpose: Extracorporeal membrane oxygenation (ECMO) has been reported to be an excellent tool to salvage patients with cardio-respiratory failure post heart transplant (HTX). We report our experience and results of ECMO support after HTX. Methods and Materials: Between May-2006 and Apr-2011, 72 adult HTX were performed in 71 patients. Twelve episodes of ECMO were used in 10 patients during this period (Group-1). Veno-arterial ECMO (VA-ECMO)
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
Results: All 3 groups had similar 5-year survival and freedom from TCAD. The 2 TR groups had similar dilated right atria and ventricles and reduced right ventricular ejection fraction (RVEF) as well as need for TV surgery (table). The low pressure TR group had significantly more flail TV leaflets (likely due to complications of heart biopsy).
Outcomes 5-Year Actuarial Survival 5-Year Freedom from CAV Pulmonary Artery Pressure (Mean PAP mmHg ⫾ SD) Dilated Right Atrium Dilated Right Ventricle Right Ventricular Dysfunction (Reduced RVEF) Flail Leaflets Need for tricuspid valve repair/ replacement
Control (No Early TR) (N⫽558)
High Pressure TR (N⫽27)
Low Pressure TR (N⫽9)
P-Value
82% 90% N/A
74% 89% 47 ⫾ 14
67% 100% 25 ⫾ 2
0.27 0.60 ⬍ 0.001
N/A N/A N/A
67% 48% 19%
44% 56% 33%
N/A N/A
0% 0%
56% 11%
0.25 0.71 0.37 ⬍ 0.001 0.08
Conclusions: Moderate-severe TR in the 1st yr after HTx does not appear to affect 5-year outcome but results in right ventricular enlargement and dysfunction. Flail tricuspid valves (most likely iatrogenic) occur rarely (⬍2%). Longer term follow-up may reveal increased need for tricuspid valve surgery. 680 Prognostic Value of Supraventricular Rhythm Disturbances among Patients Late after Heart Transplantation – Single Center Experience M. Sobieszczanska-Malek,1 T. Zielinski,1 M. Piotrowska,1 K. Komuda,1 J. Rozanski,2 J. Korewicki.1 1Heart Failure and Transplantology Department, Institute of Cardiology, Warsaw, Poland; 2Cardiosurgery Department, Institute of Cardiology, Warsaw, Poland. Purpose: Prognostic value of supraventricular rhythm disturbances, especially paroxysmal atrial fibrillation in pts after heart transplantation (HT) is not clearly defined. Aim of the study: Does supraventricular arrhythmia occurring later than 30 days after HT has a prognostic value. Methods and Materials: We analyzed medical records of 179 pts (146 men) after HT done between 2001- 2011. Mean age 45⫹/⫺15,5y. Mean observation time 4,5⫹/⫺3,3y. Episodes of supraventricular arrhythmia: atrial fibrillation (FA), supraventricular rhythm disturbances (SE_T) which occurred later than 30 days after HT not linked with acute cellular rejection or dyselectrolitemia were analysed. Survival was analyzed using Kaplan Meier curves and log rank test. Additionally we analysed the frequency of supraventricular arrhythmia in connection by type of surgical procedure (biatrial vs bicaval transplantation).
78 pts had bicaval HT. Supraventricular rhythm disturbances were recognised in 26 of 101 pts (26%) patients after biatrial type of HT and in 1 pts of 78 after bicaval transplantation(1%) p⬍ 0,0001. Conclusions: 1. Patients with supraventricular rhythm disturbances occurring at least 30 days after HT (not connected with dyselctrolitemia or acute rejection) have lower survival. 2. Bicaval type of transplantation is linked with lower risk of late supraventricular rhythm disturbances. 681 Severe Acute Kidney Injury Is the Most Powerful Predictor of Mortality after Heart Transplantation J. Shatrov,1 J. Sevastos,1,2 G. Jones,1,3 L.T. Lam,1 C. Hayward,4,5,6 A.M. Keogh,4,5,6 E. Kotlyar,4,6 P.S. Macdonald,4,5,6 P.M. Spratt.4 1 Medicine, University of Notre Dame, Darlinghurst, NSW, Australia; 2 Renal Medicine, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 3 Chemical Pathology, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 4Cardiopulmonary Transplant Unit, St Vincent’s Hospital, Darlinghurst, NSW, Australia; 5Transplantation Research Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia; 6 Medicine, University of New South Wales, Darlinghurst, NSW, Australia. Purpose: Pre-existing renal dysfunction is a well-recognised risk factor for increased mortality after heart transplantation. The aim of this study was to determine the relationship between peri-operative acute kidney injury (AKI) and subsequent mortality after heart transplantation (HTx). Methods and Materials: We retrospectively reviewed recipient, donor & procedural data (including peri-operative renal function, need for dialysis, length of stay (LOS) and survival outcomes of 194 consecutive HTx recipients who underwent HTx between August 2000 and June 2010. All patients were followed for at least 12 months. AKI was defined according to the RIFLE criteria established by Acute Dialysis Quality Initiative Workgroup. Results: Mean LOS post HTx was 27⫾26 days (median 18 days). Post HTx survival at 1 month, 1 and 5 years was 95⫾2%, 90⫾2 %, and 82⫾ 3 %, respectively. The number of patients with AKI according to the RIFLE classification was: no injury 80 (41%), risk 48 (25%), injured 37 (19%) and failure 29 (15%). Patients with failure (RIFLE-F) tended to be older and had higher rates of pre HTx hypertension (p⬍ 0.05) and pre HTx moderate/ severe chronic renal dysfunction (p ⫽ 0.02). Variables not associated with AKI included pre HTx diabetes, donor age, ischaemic time and primary graft failure which occurred in 32 recipients. Of 21 selected recipient, donor and procedural variables, only pre HTx eGFR and and AKI grade were significantly associated with LOS (p⬍0.005 and p⬍0.0001 respectively). On multivariate analysis, AKI grade (RIFLE-F) was the only independent variable associated with post HTx survival. One month, 1 and 5 year mortality for RIFLE-F patients was 18⫾7%, 29⫾9%, and 36⫾9%, versus 1⫾1%,5⫾2%, and 14⫾4% for HTx recipients with lesser grades of AKI (p,0.005). Conclusions: Severe AKI is uncommon after HTx but is associated with increased LOS and markedly increased mortality. Risk factors for AKI include older recipient age, pre HTx hypertension and pre HTx moderate/ severe chronic renal dysfunction. 682 Outcome of Extracorporeal Membrane Oxygenation as Short Term Mechanical Support Following Heart Transplantation: A Single Centre Experience S.R. Hosmane, R. Venkateswaran, J. Salaie, S. Williams, N. Yonan. Transplant Department, University Hospital of South Manchester, Manchester, United Kingdom.
Results: 16 pts had FA, 11 pts had SE_T and 152 had no rhythm disturbances. 41 pts died: 8 (50%) pts with FA, 6 (55%) with SE_T and 26 (17%) from all pts without rhythm disturbances. Patients with FA or SE_T had significantly poorer prognosis p⬍ 0,002. 101 pts have had biatrial HT and
Purpose: Extracorporeal membrane oxygenation (ECMO) has been reported to be an excellent tool to salvage patients with cardio-respiratory failure post heart transplant (HTX). We report our experience and results of ECMO support after HTX. Methods and Materials: Between May-2006 and Apr-2011, 72 adult HTX were performed in 71 patients. Twelve episodes of ECMO were used in 10 patients during this period (Group-1). Veno-arterial ECMO (VA-ECMO)