Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation
Por:
Barge-Caballero, E, Segovia-Cubero, J, Almenar-Bonet, L, Gonzalez-Vilchez, F, Villa-Arranz, A, Delgado-Jimenez, J, Lage-Galle, E, Perez-Villa, F, Lambert-Rodriguez, JL, Manito-Lorite, N, Arizon-Del Prado, JM, Brossa-Loidi, V, Pascual-Figal, D, De la Fuente-Galan, L, Sanz-Julve, M, Muniz-Garcia, J, Crespo-Leiro, M
Publicada:
1 jul 2013
Resumen:
Background Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation.
Methods and Results By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles.
Conclusions Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.
Filiaciones:
Barge-Caballero, E:
Hosp Univ A Coruna, Heart Transplant Unit, La Coruna 15006, Spain
Segovia-Cubero, J:
Hosp Puerta de Hierro, Heart Transplant Unit, Madrid, Spain
Almenar-Bonet, L:
Hosp Univ Politecn La Fe, Heart Transplant Unit, Valencia, Spain
Gonzalez-Vilchez, F:
Hosp Marques de Valdecilla, Heart Transplant Unit, Santander, Spain
Villa-Arranz, A:
Hosp Gen Gregorio Maranon, Heart Transplant Unit, Madrid, Spain
Delgado-Jimenez, J:
Hosp Doce Octubre, Heart Transplant Unit, Madrid, Spain
Lage-Galle, E:
Hosp Virgen del Rocio, Heart Transplant Unit, Seville, Spain
Perez-Villa, F:
Hosp Clin Barcelona, Heart Transplant Unit, Barcelona, Spain
Lambert-Rodriguez, JL:
Hosp Univ Cent Asturias, Heart Transplant Unit, Oviedo, Spain
Manito-Lorite, N:
Bellvitge Hosp, Heart Transplant Unit, Lhospitalet De Llobregat, Spain
Arizon-Del Prado, JM:
Hosp Reina Sofia, Heart Transplant Unit, Cordoba, Spain
Brossa-Loidi, V:
Hosp Santa Creu & Sant Pau, Heart Transplant Unit, Barcelona, Spain
Pascual-Figal, D:
Hosp Virgen Arrixaca, Heart Transplant Unit, Murcia, Spain
De la Fuente-Galan, L:
Hosp Clin Univ, Heart Transplant Unit, Valladolid, Spain
Sanz-Julve, M:
Hosp Miguel Servet, Heart Transplant Unit, Zaragoza, Spain
Muniz-Garcia, J:
Univ A Coruna, Inst Univ Ciencias Salud, La Coruna, Spain
Crespo-Leiro, M:
Hosp Univ A Coruna, Heart Transplant Unit, La Coruna 15006, Spain
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