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17 Outcomes of recipients with non-ischaemic heart disease after heart transplantation
  1. Maria Simonenko,
  2. Yulia Sazonova,
  3. Petr Fedotov,
  4. Vadim Rubinchik,
  5. Tatjana Pervunina,
  6. Aelita Berezina,
  7. Kirill Malikov,
  8. Andrey Bautin,
  9. Vladimir Krasnov,
  10. Vladimir Privorotskii,
  11. Dmitry Zverev,
  12. Lubov Mitrofanova,
  13. Maria Sitnikova,
  14. German Nikolaev,
  15. Michail Gordeev,
  16. Michail Karpenko
  1. Federal Almazov North-West Medical Research Centre

Abstract

Objective The aim of study was to estimate outcomes of recipients with non-ischaemic chronic heart failure (CHF) after heart transplantation (HT).

Methods From 2010 to 2016 we heart transplanted 80 recipients: 52.5% (n=42) – with non-ischaemic CHF (mean age – 38.3±2,2 years, n=4 children (mean age – 13.5±2.6 years)), 47.5% (n=38) – with ischaemic heart disease (IHD). Causes of CHF (mean LVEF – 20.9±1.8%) in non-ischaemic group: dilated cardiomyopathy (61.9%, n=26), non-compacted myocardium (21.4%, n=9), rheumatic heart disease (4.8%, n=2), arrhythmogenic right ventricular dysplasia (7.1%, n=3) and others (n=1 cardiac amyloidosis, n=1 cardiac sarcoidosis). Furthermore, 19% (n=8) of them were supported by biventricular assist device Berlin Heart EXCOR (duration on support – 234±80 days) prior HT. According to right heart catheterization results: pulmonary arterial systolic pressure (PASP) 39.9±1.9 mmHg, pulmonary vascular resistance (PVR) – 2.9±0.2 W.U. Pulmonary hypertension was diagnosed in 66.7% (n=28) recipients. There was no difference in how much time patients spent in HT waiting list (158.9±23.8 days vs. 152.4±29.4 days, p>0.05). All recipients treated by triple-drug therapy (steroids, calcineurin inhibitors, mycophenolic acid), induction: basiliximab – 62% (n=26), thymoglobulin – 38% (n=16). Outcomes of HT were estimated by survival, TTE results, frequency of rejection, frequency of cardiac allograft vasculopathy (CAV) and cardiopulmonary exercise test results.

Results After 6 year follow-up survival was comparable with IHD recipients (30.4±3,1 months vs. 27.3±4.2 months, p>0.05), but mortality during 1st yr after HT was higher in IHD group (7.1% vs. 13.1%, p<0.001). After HT non-ischaemic patients spent less time in ICU (9.3±0.9 days vs. 11.5±1.6 days, p>0.05), the same as required inotrope support (6.1±0.6 days vs. 8.5±1.4 days, p<0.05). Only 9.5% (n=4) of recipients had severe right heart failure and required extracorporeal membrane oxygenation (ECMO) support, 7% (n=3) – underwent tricuspid valve repair due to severe tricuspid regurgitation. Levosimendan treatment was successfully used in 33.3% (n=14) patients. In 1 case thoracoscopic pericardial fenestration performed. In 6 months after HT TTE results got to normal values: LVEF – 60.6±0.9%, PASP – 31.1±1.3 mm Hg; results were stable even in 1 year. During 1st yr rejection was found: R2/3A – 9.5% (n=32), AMR1 – 2.1% (n=7). Also in 1 year after HT recipients from non-ischaemic group significantly improved their physical capacity (V02peak – 11.7±0.4 ml/min/kg vs. 17.8±0.6 ml/min/kg, p<0.001). CAV was diagnosed in more than 1 year of follow-up. Furthermore, frequency of CAV was more often in IHD group (9.5% (n=4) vs. 13.2% (n=5), p<0.05).

Conclusion After HT survival and complications are comparable in recipients with IHD and non-ischaemic group.

  • heart transplantation
  • non-ischaemic heart failure
  • IHD

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