Background :
Heart transplantation (HTx) remains the most durable treatment for end-stage heart failure (HF) patients who are refractory to optimal treatment. Vasodilation, b-blockade, mineralocorticoid receptor antagonism and device therapy have increased survival and reduced morbidity in patients with HF in the last decades. This retrospective analysis of a local HTx cohort aimed to investigate how change in HF therapy impacted on the profile of HTx candidates and their posttransplant survival.
Methods:
A total of 323 HTx recipients of the Lausanne University Hospital had 328 transplant operations between 1987 and 2018. Patients were separated into 3 groups on the basis of the disposability of HF therapy: period 1 (1987-1998, n=115) when only vasodilatory and diuretic treatments were available; period 2 (1999-2010; n=106) includes the years with b-blockers, mineralocorticoid receptor antagonists (MRA), cardiac resynchronization therapy (CRT) and automated implantable cardioverter-defibrillator (AICD), while period 3 (2011-2018; n=107) was marked by the increasing use of ventricular assist devices (VAD) for bridge to transplantation (BTT).
Results:
Between the three periods, there was no difference in patient characteristics such as age (all: 50.0±13.9 years; p=0.72), male sex (all: 79%; p=0.34) and body mass index (BMI) (all: 24.7±4.6; p=0.5). Arterial hypertension was less prevalent in period 2 (period 1 vs 2 vs 3: 44 vs 28 vs 43%; p=0.047); distribution of cardiovascular risk factors was not different between groups. Left ventricular ejection fraction (LVEF) was lower in period 1 (1 vs 2 vs 3: 20.3±0.47 vs 23.9±1.2 vs 26.4±1.5%; p=0.001); maximal oxygen consumption (pVO2 13.6±3.8; p=0.34) or pulmonary vascular resistance (PVR) (2.53 ± 1.34 Wood Units; p=0.34) were not different. The distribution of HF etiologies differed between periods (p<0.001). HF therapy significantly changed, with progressive increase of b-blockers, mineralocorticoid receptor antagonists, and assist device use with time. 1-year survival after HTx was higher in period 3 (1 vs 2 vs 3: 87.2±3.2 vs 70.8±4.4 vs 93.0±2.6%; p always £0.022) without association to pretransplant parameters.
Conclusion:
This temporal analysis of a monocentric HTx cohort shows an improvement of 1-year survival after orthotopic heart transplantation in the years 2011-2018, when compared with the two earlier decades. The superior posttransplant survival in the years 2011-2018 was not related to pretransplant characteristics of HTx recipients, as the profile of HTx recipients did not largely change between the study periods.