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

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Version: Final published version
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Télécharger: 28541443_postprint.pdf (585.88 [Ko])
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Version: Author's accepted manuscript
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ID Serval
serval:BIB_22E5650465D6
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
The impact of multidisciplinary care on early morbidity and mortality after heart transplantation.
Périodique
Interactive cardiovascular and thoracic surgery
Auteur(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
Statut éditorial
Publié
Date de publication
01/09/2017
Peer-reviewed
Oui
Volume
25
Numéro
3
Pages
384-390
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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.

Mots-clé
Early mortality, Heart transplantation, Multidisciplinary care
Pubmed
Web of science
Open Access
Oui
Création de la notice
26/05/2017 13:06
Dernière modification de la notice
20/08/2019 13:00
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