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Epidemiology, Mortality and Risk Factors of Primary and Secondary Graft Failure According with ISHLT Consensus Criteria
Abstracts S173 whom 12/17 patients had BAA (compared to 4/9 patients with other AA mechanisms, p= 0.23). Mitral isthmus dependent left AFL was ablated in 5/26 patients (19%). Connections between recipient and donor atria were encountered in 6/26 patients (23%, 3 right and 3 left). Automatic donor atrial tachycardias (AT) were ablated in 7 patients (all right sided) and recipient ATs were encountered in 7 patients (3 left, 4 right sided) and treated mainly by ablation of the inter-atrial connection. At initial presentation 2 patients were in disorganized atrial fibrillation (AF).Multiple AA were encountered in 11 patients (42%).The procedure time was 166±81 min. and the fluoroscopy time was 27±19 min. In 9 patients re-ablation was performed. Four patients have died 2.9±2.6 years after ablation. At most recent follow up(2.5±2.1 years) all patients werein sinus rhythm, however, 2 patients remain on antiarrhythmic therapy for recurrent paroxysmal AT. Conclusion: BAA was associated with late AA onset. AFL are almost exclusively found in the donor atria and right AFL may be associated with BAA. AT originated predominantly from the right sided donor atrium and the recipient atria. Multiple AA were encountered in 42% of patients, and 2/26 patients presented with disorganized AF. Recipient to donor atrial connections were ablated in 6/26 patients. The outcome of catheter ablation in OHT patients is excellent.
Methods: All patients transplanted in our center between 09-1987 and 10-2010 were included. No patient was lost to follow-up. Mortality data were analysed as of 10-2010. Cox regression proportional hazard models were used and univariate and multivariate analyses were performed. Results: 461 heart transplant patients (371 men, aged 50+/-2 years, BMI 23.9+/-3.9 kg/m2) were included. The mean follow up was 12+/-7 years. Three months after HTx the patients had the HR of 86±14 bpm. At univariate analysis the following variables were related to survival: age, BMI, sex, origin of cardiomyopathy, ICU and total hospitalization length, as well as HR, mean pulmonary pressure (mPAP), pulmonary capillary pressure and right atrial pressure at 3 months follow-up. The age, hospitalization duration, HR and mPAP at 3 months, were related to survival in a multivariate model (Table 1). During follow-up 266 patients did not take beta blockers at any time, while 189 patients were taking beta blockers at least during one yearly control. Beta blocker use was related to outcome (Table 1) and patients from beta blocker group presented with better survival in comparison to those who never took them (Figure 1). Conclusion: Heart rate after heart transplantation is an independent predictor of outcome. Beta blockers can positively modulate the survival after heart transplantation.
4( 60) Epidemiology, Mortality and Risk Factors of Primary and Secondary Graft Failure According with ISHLT Consensus Criteria G. Vitale ,1 M. Sabatino,2 L. Potena,2 C. Lonetti,2 M. Fanizza,2 M. Luciani,2 A. Loforte,2 S. Martin Suarez,2 G. Marinelli,2 C. Rapezzi,2 F. Grigioni.2 1ISMETT, Palermo, Italy; 2University of Bologna, Bologna, Italy. Purpose: Early Graft Failure (GF) is a threatening complication after heart transplantation (HT), characterized by a severe, dysfunction of the graft. In the effort of standardizing GF definition to improve the understanding of etiologies and treatment of this serious condition, a recent ISHLT consensus conference proposed new criteria to define GF occurrence, etiology, and severity. With the purpose of verifying clinical relevance of these criteria, we reviewed early GF epidemiology in our Center. Methods: All recipients receiving HT between 1999 and 2012 were included. GF was defined according to the new ISHLT consensus conference criteria, including severity grading, primary and secondary GF, and their association with in-hospital mortality and risk factors. Results: We included 410 patients, (age 52±12y, 81% male). Of these, 49 (12%) experienced GF within 24h from surgery: 30 (7%) had primary GF and 19 (5%) had secondary GF, mostly due to pre-HT pulmonary hypertension. Primary GF was mostly characterized (70%) by biventricular dysfunction, while isolated right ventricular dysfunction characterized 84% of secondary GF cases. ECMO was used in 53% cases of primary GF, and only in 16% of cases of secondary GF. As compared with recipients with normal graft function, GF was associated with significantly higher mortality rate (41 vs. 4%; P< 0.01). Mortality progressively increased with GF severity, being 23% in patients with mild GF, and 64% in those with severe GF (P< 0.01). Although mortality was not different between primary and secondary GF (40 vs. 42%; P= n.s.), mild secondary GF had a worse outcome than mild primary GF (37 vs. 7%; P= 0.05) Female recipients (P< 0.01), cold ischemic time greater than 4h (P= 0.03), and female donor (P= 0.03) were the most relevant factors associated with early GF. Conclusion: Novel ISHLT definition and grading of primary and secondary GF is effective in identifying patients at high risk for mortality early after HT. Both primary and secondary GF are associated with extremely poor prognosis. Improvement of organ preservation strategies, and aggressive management to support right ventricle in secondary GF may help to improve outcomes.
Predictors of long term outcome in HTX patients, adjusted for the effect of beta blockers Variable
HR
IC 95%
p
Age, yrs Hospitalization after HTX, days HR at 3 months, bpm mPAP at 3 months, mmHg Treatment by beta blockers
1.05 1.01 1.02 1.05 0.67
1.03-1.07 1.00-1.02 1.01-1.03 1.01-1.09 0.47-0.95
< 0.0001 0.005 0.003 0.01 0.025
4 ( 61)
4( 62)
Heart Rate After Heart Transplantation - An Independent Predictor of Long Term Survival. Impact of Beta Blockade on Mortality After Heart Transplantation A. Ciarka , J. Van Cleemput, W. Droogne, G. Voros, B. Meyns, S. Janssens, J. Vanhaecke. Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
Maintained Cardiac Reserve in Heart Transplant Patients During Early Calcineurin Inhibitor Avoidance: A Substudy of a Randomised Controlled Trial (SCHEDULE Trial) S. Bartfay ,1 L. Gullestad,2 V. Sigurdardottir,3 A.K. Andreassen,2 E. Gude,2 B. Andersson.1 1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; 2Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 3Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
Purpose: Heart (HR) is an important predictor of mortality. Some reports relate HR after heart transplantation (HTx) to middle term survival. We investigated whether tachycardia in patients after HTx is related to long term mortality.
Purpose: Calcineurin inhibitors have been the cornerstone of immunosuppressive regime following heart transplantation. The transplanted heart is
Methods: All patients transplanted in our center between 09-1987 and 10-2010 were included. No patient was lost to follow-up. Mortality data were analysed as of 10-2010. Cox regression proportional hazard models were used and univariate and multivariate analyses were performed. Results: 461 heart transplant patients (371 men, aged 50+/-2 years, BMI 23.9+/-3.9 kg/m2) were included. The mean follow up was 12+/-7 years. Three months after HTx the patients had the HR of 86±14 bpm. At univariate analysis the following variables were related to survival: age, BMI, sex, origin of cardiomyopathy, ICU and total hospitalization length, as well as HR, mean pulmonary pressure (mPAP), pulmonary capillary pressure and right atrial pressure at 3 months follow-up. The age, hospitalization duration, HR and mPAP at 3 months, were related to survival in a multivariate model (Table 1). During follow-up 266 patients did not take beta blockers at any time, while 189 patients were taking beta blockers at least during one yearly control. Beta blocker use was related to outcome (Table 1) and patients from beta blocker group presented with better survival in comparison to those who never took them (Figure 1). Conclusion: Heart rate after heart transplantation is an independent predictor of outcome. Beta blockers can positively modulate the survival after heart transplantation.
4( 60) Epidemiology, Mortality and Risk Factors of Primary and Secondary Graft Failure According with ISHLT Consensus Criteria G. Vitale ,1 M. Sabatino,2 L. Potena,2 C. Lonetti,2 M. Fanizza,2 M. Luciani,2 A. Loforte,2 S. Martin Suarez,2 G. Marinelli,2 C. Rapezzi,2 F. Grigioni.2 1ISMETT, Palermo, Italy; 2University of Bologna, Bologna, Italy. Purpose: Early Graft Failure (GF) is a threatening complication after heart transplantation (HT), characterized by a severe, dysfunction of the graft. In the effort of standardizing GF definition to improve the understanding of etiologies and treatment of this serious condition, a recent ISHLT consensus conference proposed new criteria to define GF occurrence, etiology, and severity. With the purpose of verifying clinical relevance of these criteria, we reviewed early GF epidemiology in our Center. Methods: All recipients receiving HT between 1999 and 2012 were included. GF was defined according to the new ISHLT consensus conference criteria, including severity grading, primary and secondary GF, and their association with in-hospital mortality and risk factors. Results: We included 410 patients, (age 52±12y, 81% male). Of these, 49 (12%) experienced GF within 24h from surgery: 30 (7%) had primary GF and 19 (5%) had secondary GF, mostly due to pre-HT pulmonary hypertension. Primary GF was mostly characterized (70%) by biventricular dysfunction, while isolated right ventricular dysfunction characterized 84% of secondary GF cases. ECMO was used in 53% cases of primary GF, and only in 16% of cases of secondary GF. As compared with recipients with normal graft function, GF was associated with significantly higher mortality rate (41 vs. 4%; P< 0.01). Mortality progressively increased with GF severity, being 23% in patients with mild GF, and 64% in those with severe GF (P< 0.01). Although mortality was not different between primary and secondary GF (40 vs. 42%; P= n.s.), mild secondary GF had a worse outcome than mild primary GF (37 vs. 7%; P= 0.05) Female recipients (P< 0.01), cold ischemic time greater than 4h (P= 0.03), and female donor (P= 0.03) were the most relevant factors associated with early GF. Conclusion: Novel ISHLT definition and grading of primary and secondary GF is effective in identifying patients at high risk for mortality early after HT. Both primary and secondary GF are associated with extremely poor prognosis. Improvement of organ preservation strategies, and aggressive management to support right ventricle in secondary GF may help to improve outcomes.
Predictors of long term outcome in HTX patients, adjusted for the effect of beta blockers Variable
HR
IC 95%
p
Age, yrs Hospitalization after HTX, days HR at 3 months, bpm mPAP at 3 months, mmHg Treatment by beta blockers
1.05 1.01 1.02 1.05 0.67
1.03-1.07 1.00-1.02 1.01-1.03 1.01-1.09 0.47-0.95
< 0.0001 0.005 0.003 0.01 0.025
4 ( 61)
4( 62)
Heart Rate After Heart Transplantation - An Independent Predictor of Long Term Survival. Impact of Beta Blockade on Mortality After Heart Transplantation A. Ciarka , J. Van Cleemput, W. Droogne, G. Voros, B. Meyns, S. Janssens, J. Vanhaecke. Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
Maintained Cardiac Reserve in Heart Transplant Patients During Early Calcineurin Inhibitor Avoidance: A Substudy of a Randomised Controlled Trial (SCHEDULE Trial) S. Bartfay ,1 L. Gullestad,2 V. Sigurdardottir,3 A.K. Andreassen,2 E. Gude,2 B. Andersson.1 1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; 2Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 3Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
Purpose: Heart (HR) is an important predictor of mortality. Some reports relate HR after heart transplantation (HTx) to middle term survival. We investigated whether tachycardia in patients after HTx is related to long term mortality.
Purpose: Calcineurin inhibitors have been the cornerstone of immunosuppressive regime following heart transplantation. The transplanted heart is