{"title":"Determinants of Short-Term Survival After Heart Transplantation in Patients Bridged to Transplant With Left Ventricular Assist Device.","authors":"Suat Şenkaya, Ümit Kahraman, Ayşen Yaprak Kapkın, Özlem Balcıoğlu, Sanem Nalbantgil, Çağatay Engin, Tahir Yağdı, Mustafa Özbaran","doi":"10.1016/j.transproceed.2025.08.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The bridge to heart transplantation has been the subject of intense debate. This study aimed to determine the factors affecting early survival after bridge to heart transplantation.</p><p><strong>Methods: </strong>Between 2011 and 2019, patients who underwent a bridge to heart transplantation in a single center were retrospectively scanned. Demographics, complications of left ventricular assist device (LVAD), cardiopulmonary bypass (CPB), and cross-clamp duration, use of blood products, length of ventricular assist device (VAD) support, post-transplant hospital stay, post-transplant complications, and in-hospital mortality rates were recorded.</p><p><strong>Results: </strong>Patients (n = 60) were divided into 2 groups; patients with 30-day mortality (group 1, n = 10) and those with survival longer than 30 days (group 2, n = 50). The patients in group 1 were found to be older (P = .009), supported for a longer duration (P = .027), have higher International Normalized Ratio (INR) levels (P = .025), and have device-specific infection more commonly (P = .003). Cardiac ischemia (P = .013) and CPB (P = .006) durations were longer in group 1. Use of blood products and nitric oxide (NO) was more frequent in group 1 (P < .05). Post-transplantation complications (stroke, sepsis, kidney failure, arrhythmia, need for intra-aortic balloon pump [IABP], and short-term mechanical circulatory support [MCS]) were significantly more common in group 1 patients (P < .05). Blood products (0.920 for red blood cells, 0.901 for fresh frozen plasma, and 0.885 for platelets), postoperative high creatinine (0.817) and lactate (0.715), and device-specific infection (0.686) had the highest area under the curve values in the receiver operating characteristic (ROC).</p><p><strong>Conclusions: </strong>Bridge to transplantation has its own challenges of being a reoperation under high INR levels. Recurrent infection attacks and an inflammatory state may be limiting the healing process. Device-specific infection may be a major reason for early mortality whereas it is also a major indication for urging heart transplantation.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation proceedings","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.transproceed.2025.08.005","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
Background: The bridge to heart transplantation has been the subject of intense debate. This study aimed to determine the factors affecting early survival after bridge to heart transplantation.
Methods: Between 2011 and 2019, patients who underwent a bridge to heart transplantation in a single center were retrospectively scanned. Demographics, complications of left ventricular assist device (LVAD), cardiopulmonary bypass (CPB), and cross-clamp duration, use of blood products, length of ventricular assist device (VAD) support, post-transplant hospital stay, post-transplant complications, and in-hospital mortality rates were recorded.
Results: Patients (n = 60) were divided into 2 groups; patients with 30-day mortality (group 1, n = 10) and those with survival longer than 30 days (group 2, n = 50). The patients in group 1 were found to be older (P = .009), supported for a longer duration (P = .027), have higher International Normalized Ratio (INR) levels (P = .025), and have device-specific infection more commonly (P = .003). Cardiac ischemia (P = .013) and CPB (P = .006) durations were longer in group 1. Use of blood products and nitric oxide (NO) was more frequent in group 1 (P < .05). Post-transplantation complications (stroke, sepsis, kidney failure, arrhythmia, need for intra-aortic balloon pump [IABP], and short-term mechanical circulatory support [MCS]) were significantly more common in group 1 patients (P < .05). Blood products (0.920 for red blood cells, 0.901 for fresh frozen plasma, and 0.885 for platelets), postoperative high creatinine (0.817) and lactate (0.715), and device-specific infection (0.686) had the highest area under the curve values in the receiver operating characteristic (ROC).
Conclusions: Bridge to transplantation has its own challenges of being a reoperation under high INR levels. Recurrent infection attacks and an inflammatory state may be limiting the healing process. Device-specific infection may be a major reason for early mortality whereas it is also a major indication for urging heart transplantation.
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