Outcomes of heart failure patients excluded from heart transplant waiting list
Maria Simonenko1, Petr Fedotov2, Artem Kostomarov2, Yulia Sazonova3, Andrei Bautin4, Alexandr Marichev4, German Nikolaev3, Mikhail Gordeev5, Maria Sitnikova2, Mikhail Karpenko6.
1Heart transplantation Outpatient Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 2Heart Failure Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 3Thoracic Surgery Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 4Research Laboratory of Anesthesiology and Resuscitation, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 5Cardiothoracic surgery research department, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 6Scientific and Clinical Council, First Deputy General Director, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
Background: Every year the number of heart transplant recipients increases but the number of patients in the heart transplant waiting list (HTx WL) does not slow down. However, there are no data on those excluded from HTx WL. The aim was to study clinical differences of chronic heart failure (CHF) patients who excluded from a HTx WL and estimate their survival.
Methods: We retrospectively analyzed HTx WL data that was collected from 2010 to 2020 and included 280 patients: 47.4±12.8 year-old, male –210 (75%). We estimated the number of excluded patients, causes of the exclusion and patients’ clinical characteristics. Data was analyzed by using the SPSS 21.0.
Results: During 10-year follow-up 53 patients (class III by NYHA, class 2 UNOS) excluded from HTx WL: 66% (n=35; 55.4±12.5 year-old; n=33 - male) – improved (group 1), 9% (n=5; 50 [37;56] year-old; male) refused after the inclusion for their personal reasons (group 2) and 25% (n=13; 58 [46;63] year-old; n=12 - male) – due to diagnosed contraindications (group 3). Most common cause of CHF was ischaemic heart disease (49%, 60% and 69%, respectively). Patients excluded from HTx WL due to their improvement in 17 [8;43] days. LVEF were 21 [17;24] %, 13 [10;17] % and 18 [16;28] %, respectively, (p1,2=0.013) and PASP - 44±20 mm Hg, 45 [43;47] mm Hg and 59 [40;67] mm Hg, respectively, (p1,2=0.02). VO2peak was <10-12 ml/kg/min. There was a high incidence of pulmonary hypertension (PHT) in the group 3, including irreversible. NT-proBNP levels were 2556 [1698;3680] pg/ml, 9212 [6226;14508] pg/ml and 3054 [1751;4304] pg/ml, respectively, (p1,2=0.005, p2,3=0.03). After the inclusion in HTx WL, patients completed the SF-36 questionnaire and results did not show significant differences between the groups (p>0.05). One year survival after exclusion was 86% in the group 1, 20% - group 2 and 38% – group 3. Two years after the exclusion 2 patients were put back on HTx WL and then successfully underwent heart transplantation. Mortality of excluded individuals was associated with a higher level of PAWP (r=0.72, p=0.01), a low level of venous oxygen saturation of the central venous blood (r=-0.86, p=0.02), heart rate (r=0.61, p=0.03) and QRS width (r=0.52, p=0.04).
Conclusion: In 10 years 19% of patients were excluded from HTx WL, most of them due to the improvement and this one had a higher survival. Most of patients excluded due to irreversible PHT but those who decided to refuse had the lower LVEF. Clinical characteristics, except LVEF and right heart failure, were similar between excluded ones.
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