The impact of multidisciplinary care on early morbidity and mortality after heart transplantation.

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Serval ID
serval:BIB_22E5650465D6
Type
Article: article from journal or magazin.
Collection
Publications
Title
The impact of multidisciplinary care on early morbidity and mortality after heart transplantation.
Journal
Interactive cardiovascular and thoracic surgery
Author(s)
Schmidhauser M., Regamey J., Pilon N., Pascual M., Rotman S., Banfi C., Prêtre R., Meyer P., Antonietti J.P., Hullin R.
ISSN
1569-9285 (Electronic)
ISSN-L
1569-9285
Publication state
Published
Issued date
01/09/2017
Peer-reviewed
Oui
Volume
25
Number
3
Pages
384-390
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The impact of multidisciplinary care on outcome after heart transplantation (HTx) remains unclear.
This retrospective study investigates the impact of multidisciplinary care on the primary end point 1-year all-cause mortality (ACM) and the secondary end point mean acute cellular rejection (ACR) grade within the first postoperative year.
This study includes a total 140 HTx recipients (median age: 53.5 years; males: 80%; donor/recipient gender mismatch: 38.3%; mean length of in-hospital stay: 34 days; mean donor age: 41 years). Multidisciplinary care was implemented in 2008, 66 HTx recipients had operation in 2000-07 and 74 patients had HTx thereafter (2008-14). Non-ischaemic dilated cardiomyopathy was more prevalent in HTx recipients of 2000-07 (63.6 vs 43.2%; P = 0.024). Pre-transplant mechanical circulatory support was more frequent in 2008-14 (9.1 vs 24.3%; P = 0.030). Groups were not different for pre-transplant cardiovascular risk factors or other comorbidity, invasive haemodynamics or echocardiographic parameters. In-hospital and 1-year ACM were numerically lower in 2008-14 (16.2 vs 22.2%; 18.9% vs 25.8%; P = 0.47/0.47, respectively). In 2000-07, pre-transplant weight and diabetes mellitus predicted in-hospital ACM (odds ratio -0.14, P = 0.02; OR 5.24, P = 0.01, respectively) while post-transplant length of in-hospital stay was related with in-hospital ACM (odds ratio -0.10; P = 0.016) and 1-year ACM (odds ratio -0.07; P = 0.007). In 2000-07, the mean grade of ACR within the first postoperative year was higher (0.65 vs 0.20; P < 0.0001) and ≥moderate ACR was associated with in-hospital mortality (χ2 = 3.92; P = 0.048).
Multidisciplinary care in HTx compensates post-transplant risk associated with pre-transplant disease and has beneficial impact on the incidence of ACR and ACR-associated early mortality.

Keywords
Early mortality, Heart transplantation, Multidisciplinary care
Pubmed
Web of science
Open Access
Yes
Create date
26/05/2017 14:06
Last modification date
20/08/2019 14:00
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