Risk Factors and Prognostic Implications of Perioperative Stroke after Heart Transplantation: An Analysis of the United Network for Organ Sharing Database 2009-2019

Abstract

Purpose The purpose of our study was to evaluate risk factors and prognostic implications of perioperative stroke in heart transplantation. Methods We conducted a retrospective review of the UNOS database between 2009 and 2019 to identify adult patients (≥18years) who underwent orthotopic heart transplantation (OHT). Patients who received a multi‐organ transplant or second heart transplant were excluded. Patients were divided according to the presence or absence of perioperative stroke. Baseline characteristics and clinical status were recorded. The primary endpoint was all‐cause mortality. Results During the study period, there were 26,518 isolated heart transplants, we excluded 4,266 because of age, 615 because of the previous history of transplantation, and 211 because of missing stroke information. A total of 21,426 patients were included in the study, among them 588 (2.7%) experienced a perioperative stroke during the index hospitalization. In the multivariable analysis, ECMO (Extracorporeal membrane oxygenation) (adjusted Odds Ratio (aOR): 5.46, 95% Confidence Interval (CI) 2.09-14.3; p Conclusion Perioperative stroke after heart transplantation is infrequent but associated with increased mortality. The presence of ECMO, prior LVAD, and prior cardiac surgery were among the risk factors identified.