Cumulative Effect of Preoperative Risk Factors on Mortality after Pediatric Heart Transplantation.

TitleCumulative Effect of Preoperative Risk Factors on Mortality after Pediatric Heart Transplantation.
Publication TypeJournal Article
Year of Publication2018
AuthorsO'Connor MJ, Glatz AC, Rossano JW, Shaddy RE, Ryan R, Ravishankar C, Fuller S, Mascio CE, J Gaynor W, Lin KY
JournalAnn Thorac Surg
Date Published2018 Apr 20
ISSN1552-6259
Abstract

BACKGROUND: Risk assessment in heart transplantation is critical for candidate selection, but current models inadequately assess individual risk of postoperative mortality. We sought to identify risk factors and develop a scoring system to predict mortality following heart transplantation in children.

METHODS: The records of patients undergoing heart transplantation at our institution from 2010 - 2016 were reviewed. Clinical characteristics were recorded and compared between survivors and non-survivors. Using Cox proportional hazard modeling, a risk factor score was developed using factors associated with postoperative mortality.

RESULTS: Seventy-four patients underwent heart transplantation at a mean age of 8.8 ± 6.6 years. Congenital heart disease was the most common indication, comprising 48.6% of the cohort. Overall mortality was 18.9%, with 10/14 dying ≤30 days of operation or during initial postoperative admission (early mortality). The following preoperative factors were associated with overall mortality: single ventricle congenital heart disease (HR 3.2, p = 0.042), biVAD (HR 4.8, p = 0.043), history of ≥4 sternotomies (HR 3.9, p = 0.023), panel reactive antibody > 10% (HR 4.4, p = 0.013), any previous surgery at an outside institution (HR 3.2, p = 0.038), and pulmonary vein disease (HR 4.7, p = 0.045). Each risk factor was assigned a point value, based on similar magnitude of the hazard ratios. A score of ≥4 predicted mortality with 57% sensitivity and 90% specificity.

CONCLUSIONS: In this single-center pediatric cohort, post-heart transplantation mortality could be predicted using patient-specific risk factors. The cumulative effect of these risk factors predicted mortality with high specificity.

DOI10.1016/j.athoracsur.2018.03.044
Alternate JournalAnn. Thorac. Surg.
PubMed ID29684375