Anne Ingels

Impact of donor comorbidities on heart transplant outcomes in the modern era

OBJECTIVES The use of marginal donors with cardiovascular risk factors is increasing due to organ shortage but remains controversial in heart transplantation (HTx). We sought to investigate post-transplant outcomes in the recent era taking into account donor characteristics. METHODS We reviewed 261 HTx performed in our hospital between January 1996 and March 2013. Donor characteristics were obtained from the national database. The incidence of primary graft dysfunction (PGD) and cardiac allograft vasculopathy (CAV) and overall survival were compared in 2 groups of HTx recipients: those receiving transplants from 1996 to 2004 (Group A, n =  120) and from 2005 to 2013 (Group B, n =  141). RESULTS The mean age of the donors was 34 ± 12 years in Group A vs 42 ± 13 years in Group B ( P  < 0.001). Donors in Group B had a higher body mass index (23 ± 2 vs 26 ± 5 kg/m 2 , P  < 0.001), were more likely to be smokers (29.6% vs 52.9%, P  < 0.001) and were more likely to have hypertension (5% vs 13.5%, P  = 0.030). There was no difference in survival at 1 and 5 years (79% and 63% in Group A vs 80% and 62% in Group B, respectively; P  = 0.551). The rate of PGD was 36% in Group A vs 40% in Group B ( P  = 0.092). Freedom from CAV at 5 years was 64% and 61%, respectively ( P  = 0.367). Among the characteristics of the donors, only hypertension was associated with reduced survival. CONCLUSIONS The use of older cardiac donors with more cardiovascular comorbidities in the recent era did not impair the post-transplant outcomes. Donor hypertension was the only determinant of worse survival.

0418: Comparison of pre- and post-operative characteristics in octogenarians having isolated surgical aortic valve replacement before versus after introduction of transcatheter aortic valve implantation

Download : Download high-res image (100KB) Download : Download full-size image Abstract 0418 – Figure Surgical aortic valve replacement (SAVR) is the reference treatment for severe aortic stenosis (AS). Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, between January 2006 and December 2014 in a single high-volume center. We compared preoperative, peri-operative and postoperative characteristics before and after the initiation of TAVI (February 2009). 845 patients were included: 229 in the pre-TAVI group (2006-2008; 3 years), 616 in the post-TAVI group (2009-2014; 6 years). Over time, there was an increased rate of SAVR performed. The mean age was the same, 83.2±2.0 years in the pre-TAVI group, 83.5±2.1 years in the post-TAVI group (p=0.06). The preoperative characteristics were statistically comparable, except for history of heart failure (25% in the pre-TAVI group vs 18% in the post-TAVI group, p=0.04), coronary artery disease (22% in the pre-TAVI group vs 14% in the post-TAVI group, p=0.01), hypertension (59% in the pre-TAVI group vs 68% in the post-TAVI group, p=0.02) and obesity (18% in the pre-TAVI group vs 24% in the post-TAVI group, p=0.03). Peri-operative data and post-operative adverse events were comparable between both groups. The operative mortality (30-day) was similar, 5.2% in the pre-TAVI group, 5.5% in the post-TAVI group (p=0.87). In conclusion, with the emergence of TAVI, the number of octogenarian patients operated on continued to increase, their preoperative characteristics were clinically similar and the operative mortality was stable.