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

Schmidhauser, Marie ; Regamey, Julien ; Pilon, Nathalie ; Pascual, Manuel ; Rotman, Sam ; Banfi, Carlo ; Prêtre, René ; Meyer, Philippe ; Antonietti, Jean-Philippe ; Hullin, Roger

In: Interactive CardioVascular and Thoracic Surgery, 2017, vol. 25, no. 3, p. 384-390

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    Titel
    • The impact of multidisciplinary care on early morbidity and mortality after heart transplantation
    Autor
    • Schmidhauser, Marie. Service de Cardiologie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Regamey, Julien. Service de Cardiologie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Pilon, Nathalie. Département Chirurgie et Anesthésiologie, Centre de Transplantation d'Organes Solides, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Pascual, Manuel. Département Chirurgie et Anesthésiologie, Centre de Transplantation d'Organes Solides, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Rotman, Sam. Département des Laboratoires, Institut de Pathologie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Banfi, Carlo. Service de Chirurgie Cardiaque, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
    • Prêtre, René. Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    • Meyer, Philippe. Service de Cardiologie, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
    • Antonietti, Jean-Philippe. Faculté des Sciences Sociales et Politiques, Institute of Psychology, Bâtiment Géopolis, Quartier UNIL-Dorigny, University of Lausanne, Lausanne, Switzerland
    • Hullin, Roger. Service de Cardiologie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Interactive CardioVascular and Thoracic Surgery, 2017, vol. 25, no. 3, p. 384-390. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:331017
    Summary
    Abstract OBJECTIVES The impact of multidisciplinary care on outcome after heart transplantation (HTx) remains unclear. METHODS 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. RESULTS 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). CONCLUSIONS 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.