Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients
Objective: End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-11-01
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| Series: | Indian Heart Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0019483220302339 |
| _version_ | 1819094718725750784 |
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| author | K.R. Balakrishnan K.G. Sureshrao R. Ravikumar T. Muralikrishna K. Ganapathy Subramaniam R. Mohan A. Ajay K. Ramasubramanian D. Jagdish R. Veena |
| author_facet | K.R. Balakrishnan K.G. Sureshrao R. Ravikumar T. Muralikrishna K. Ganapathy Subramaniam R. Mohan A. Ajay K. Ramasubramanian D. Jagdish R. Veena |
| author_sort | K.R. Balakrishnan |
| collection | DOAJ |
| description | Objective: End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.1 1 To document the short term and medium term survival of patients undergoing a heart transplant procedure 2 To identify the risk factors for unfavorable outcomes with subgroup analysis. Methods: The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category. Results: There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50. Conclusion: Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country. |
| first_indexed | 2024-12-21T23:31:52Z |
| format | Article |
| id | doaj.art-5365c7dffabf4d6dac63a618c8702d45 |
| institution | Directory Open Access Journal |
| issn | 0019-4832 |
| language | English |
| last_indexed | 2024-12-21T23:31:52Z |
| publishDate | 2020-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Heart Journal |
| spelling | doaj.art-5365c7dffabf4d6dac63a618c8702d452022-12-21T18:46:29ZengElsevierIndian Heart Journal0019-48322020-11-01726524534Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patientsK.R. Balakrishnan0K.G. Sureshrao1R. Ravikumar2T. Muralikrishna3K. Ganapathy Subramaniam4R. Mohan5A. Ajay6K. Ramasubramanian7D. Jagdish8R. Veena9Department of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaCorresponding author.; Department of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaDepartment of Heart and Lung Transplantation, MGM Hospital, 72, Nelson Manickam Road, Aminjikarai, Chennai, 600029, IndiaObjective: End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.1 1 To document the short term and medium term survival of patients undergoing a heart transplant procedure 2 To identify the risk factors for unfavorable outcomes with subgroup analysis. Methods: The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category. Results: There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50. Conclusion: Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.http://www.sciencedirect.com/science/article/pii/S0019483220302339Heart transplantationIndian subcontinentMedium term survivalRisk factors correlation |
| spellingShingle | K.R. Balakrishnan K.G. Sureshrao R. Ravikumar T. Muralikrishna K. Ganapathy Subramaniam R. Mohan A. Ajay K. Ramasubramanian D. Jagdish R. Veena Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients Indian Heart Journal Heart transplantation Indian subcontinent Medium term survival Risk factors correlation |
| title | Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients |
| title_full | Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients |
| title_fullStr | Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients |
| title_full_unstemmed | Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients |
| title_short | Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients |
| title_sort | medium term results following heart transplantation for end stage heart failure a single center experience of 257 patients |
| topic | Heart transplantation Indian subcontinent Medium term survival Risk factors correlation |
| url | http://www.sciencedirect.com/science/article/pii/S0019483220302339 |
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