18 Surgery for heart failure: experiences from severance cardiovascular hospital, seoul, korea

Abstract

Since the first successful heart transplant in Korea in 1992, the case volume has been rapidly increasing. Compared with ISHLT registry data, the Korean KONOS registry data show similar post-transplant long-term survival rates. At Severance Cardiovascular Hospital (SCH) of Yonsei University, the number of heart transplants has been growing steadily since 2010. Between 1994 and 2018, 174 heart transplantations had been performed. Mean age of recipients and their follow-up duration were 42.9 and 3.2 years, respectively. Pre-operative CPR was performed in 18 (10.3%) patients, and extracorporeal membrane oxygenation (ECMO) was applied in 35 (20.1%) patients. In-hospital mortality was 19% and 10 year survival rate was 71.7%. By multivariate analysis, risk factors for in-hospital mortality were pre-operative elevated bilirubin and lactate levels. Risk factors for overall mortality were pre-operative dialysis, and high bilirubin and lactate levels. Gender and pre-operative body weight mismatch and ECMO bridging were not independent risk factors for mortality. The volume of LVAD implants had been low in Korea due to reimbursement limitations. However, from October 2018, a new national insurance policy was implemented to provide for 95% of total device cost. This change is projected to increase device implant rates and patient access. In conclusion, size-mismatch did not affect LVAD outcomes for the East Asian population. Organ protection remains an important factor for long-term survival. In the short term, MCS including ECMO may be used to reverse organ dysfunction as a bridge to recovery or decision. Finally, LVAD will be a main strategy for bridge-to-transplant (BTT) in Korea.