Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Impact of early postoperative neurological events on outcome and survival after heart transplantation
D. Oehler1, M. B. Immohr2, C. Böttger3, R. R. Bruno1, D. Sigetti2, J. Haschemi1, H. Oehler4, H. Aubin2, P. Horn1, I. Tudorache2, R. Westenfeld1, P. Akhyari2, M. Kelm1, A. Lichtenberg2, U. Boeken2
1Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; 2Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf; 3Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf; 4Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg;

Objective: Neurological events (NE) during primary stay in heart transplant (HTx) recipients may be associated with reduced outcome and survival, which we aim to explore with the current study.

Methods: We screened all patients undergoing HTx in our center between 09/2010 and 04/2022 (n=241), and included 237 patients with complete data on occurrence of NE during primary stay. NE were defined as ischemic stroke, hemorrhage, hypoxic ischemic injury or acute symptomatic neurological dysfunction without CNS injury. The cohort was divided in recipients with (n=35) and without (n=202) NE after HTx. Using linear regression analysis, association of NE after HTx and survival was assessed.

Results: Recipients with NE displayed a longer ICU stay (30 vs. 15 days, p = .001), longer mechanical ventilation (195 vs. 54 hours, p = .0001), higher need for blood transfusion, more severe infections (31% vs. 22 %, p=.001) and need for hemodialysis post-HTx was substantially higher (79% vs. 54%, p=.001). Re-sternotomy (37 vs. 29%, p=0.04) and mechanical life support (ECLS) post HTx (43% vs. 26%, p = .003) was also significantly higher in patients with NE. Covariable-adjusted linear regression analysis revealed significant independent association of NE and reduced 30-day (adjusted HR 3.8, 95% CI 1.4-10.1, p= .008) and 1-year (adjusted HR 3.4, 95% CI 1.3-9.2, p= .013) survival after HTx, confirmed by reduced Kaplan-Meier survival up to 5-years after HTx (p <.001).

Conclusion: Neurological events post HTx were strongly and independently associated with worse postoperative outcome and reduced survival up to 5 years after heart transplantation.


Figure 1: Kaplan-Meier-Survival for patients with and without neurological events during index stay after heart transplantation. 



Table 1: Baseline patient characteristics, perioperative parameters, and survival after heart transplantation in relation to the occurrence of a neurological event in the index stay. 

All (n=237)

NE (n=35)

No NE (n=202)

p 1 vs 2

Age (y)

58 (50-62)

58 (47-63)

58 (50-62)

0.99

High-urgency waiting list (%)

45.1

65.7

41.6

0.01

Postoperative IMC/ICU stay (d)

16 (10-28)

30 (13-42)

15 (10-25)

0.001

Mechanical ventilation (h)

66 (25-175)

195 (93-360)

54 (24-134)

0.0001

Hemodialysis post HTx (%)

57.4

78.8

53.7

0.001

Infection/Sepsis (%)

23.2

31.4

21.8

0.01

ECLS post HTx (%)

28.7

42.8

26.2

0.003

30-day survival n (%)

215/237 (90.7)

27/35 (77.1)

188/202 (93.1)

.007

1-year survival n (%)

161/203 (79.3)

19/34 (55.9)

142/169 (84.0)

.0006
https://dgk.org/kongress_programme/jt2023/aP1736.html