Different results of cardiac transplantation in patients with ischemic and dilated cardiomyopathy

Abstract

We retrospectively analyzed 275 consecutive transplanted patients, dividing them into group A (128 patients) affected by ischemic cardiomyopathy and group B (147 patients) affected by dilated cardiomyopathy. The difference in demographic, clinical and hemodynamic preoperative and postoperative data between the groups was studied; group A patients presented at transplantation with a less compromised hemodynamic picture, requiring inotrope infusion and mechanical assistance less frequently. The influence of etiology on early postoperative complications was also analyzed: group A patients needed postoperative mechanical assistance, inotrope, infusion and prolonged mechanical ventilation more often, therefore requiring a longer stay in the intensive care unit (ICU). Hospital mortality was twice as high in group A. The older age of group A patients per se did not influence these results significantly. The long-term follow-up was then studied with particular attention to parenchymal functions, hemodynamics, coronary artery disease, metabolic and surgical complications, and survival. The complication rate was higher in group A, with more severe hypertension and higher cholesterol levels at 1 year, a higher prevalence of accelerated coronary artery disease (CAD) and a more frequent onset of insulin-dependent diabetes. Surgical and vascular complications were also more frequent. The final result was a better 5-year actuarial survival rate for group B patients. Donor and recipient ages at the time of transplant did not influence this result. We conclude that ischemic patients, even if they are transplanted in better condition and operated more electively, have a more critical early and long-term postoperative course and a worse survival rate. These findings are not explained by advanced age, but could be due to the impact of atherosclerosis and metabolic impairments associated with ischemic disease.

Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

“…However, the relationship between the primary diagnosis of HT and early AKI-D has not been identified yet despite its prognostic values for survival. Martinelli et al [ 25 ] evaluated 128 HT patients with ischemic cardiomyopathy and 147 with idiopathic dilated cardiomyopathy. They reported that patients with ischemic cardiomyopathy had a more critical stay in the hospital, which echoes our findings that up to 222 out of 278 (80%) patients with CAD required early dialysis.…”

Acute hemodynamic and functional effects of surgical ventricular restoration and heart transplantation in patients with ischemic dilated cardiomyopathy

“…CPET 5 cardiopulmonary exercise testing EF 5 ejection fraction NYHA 5 New York Heart Association SVR 5 surgical ventricular restoration V E 5 minute ventilation VO 2 5 oxygen uptake (CPET), which is a noninvasive way of evaluating patients with heart failure and is used consistently in the assessment for cardiac transplantation. Values gleaned from analyzing these test results have been a guide to treatment strategy choices used to determine long-term survival 5,6 but have not yet been compared with values achieved after SVR for dilated ischemic cardiomyopathy. The goal of evaluating patients with end-stage ischemic cardiomyopathy is to determine how oxygen uptake (VO 2 ) during exercise is changed after treatment with either ventricular restoration or heart transplantation at the 6-month postoperative interval.…”

Outcome measures for adult critical care: a systematic review.

“…Several measures of impairment of liver, kidney and other organ functions were reported ( Table 13 ). 25,38,[59][60][61] Such measures were generally only reported in one study and in none of the studies were the measurement properties in critical care investigated.…”