Severe right ventricular dysfunction is an independent predictor of pre- and post-transplant mortality among candidates for heart transplantation.
BACKGROUND
Heart transplantation is the gold-standard treatment for end-stage heart failure. However, the shortage of grafts has led to longer waiting times and increased mortality for candidates without priority.


AIMS
To study waiting-list and post-transplant mortality, and their risk factors among patients registered for heart transplantation without initial high emergency procedure.


METHODS
All patients registered on the heart transplantation waiting list (2004-2015) without initial high emergency procedure were included. Clinical, biological, echocardiographic and haemodynamic data were collected. Waiting list and 1-year post-transplant survival were analysed with a Kaplan-Meier model.


RESULTS
Of 221 patients enrolled, 168 (76.0%) were men. Mean age was 50.0±12.0 years. Forty-seven patients died on the waiting list, resulting in mortality rates of 11.2±2.7% at 1 year, 31.9±5.4% at 2 years and 49.4±7.1% at 3 years. Median survival was 36.0±4.6 months. In the multivariable analysis, left ventricular ejection fraction<30% (hazard ratio [HR]: 3.76, 95% confidence interval [CI]: 1.38-10.24; P=0.010) and severe right ventricular systolic dysfunction (HR: 2.89, 95% CI: 1.41-5.92; P=0.004) were associated with increased waiting-list mortality. The post-transplant survival rate was 73.1±4.4% at 1 year. Pretransplant severe right ventricular dysfunction and age>50 years were strong predictors of death after transplantation (HR: 5.38, 95% CI: 1.38-10.24 [P=0.020] and HR: 6.16, 95% CI: 1.62-9.32 [P=0.0130], respectively).


CONCLUSIONS
Mortality among candidates for heart transplantation remains high. Patients at highest risk of waiting-list mortality have to be promoted, but without compromising post-transplant outcomes. For this reason, candidates with severe right ventricular dysfunction are of concern, because, for them, transplantation is hazardous.
['Ravis|Eleonore|E|', 'Theron|Alexis|A|', 'Mancini|Julien|J|', 'Jaussaud|Nicolas|N|', 'Morera|Pierre|P|', 'Chalvignac|Virginie|V|', 'Guidon|Catherine|C|', 'Grisoli|Dominique|D|', 'Gariboldi|Vlad|V|', 'Riberi|Alberto|A|', 'Habib|Gilbert|G|', 'Mouly-Bandini|Annick|A|', 'Collart|Frederic|F|']
D000328:Adult D000367:Age Factors D005260:Female D005602:France D006333:Heart Failure D016027:Heart Transplantation D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D016017:Odds Ratio D016016:Proportional Hazards Models D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D012720:Severity of Illness Index D013997:Time Factors D014019:Tissue Donors D016896:Treatment Outcome D018497:Ventricular Dysfunction, Right D016278:Ventricular Function, Right D014850:Waiting Lists
Heart transplantation Heart failure Post-transplant survival Waiting-list mortality Dysfonction ventriculaire droite Insuffisance cardiaque terminale Mortalité sur liste d’attente Right ventricular function Survie post-transplantation Transplantation cardiaque