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Updated: Sep 26, 2025
Optimization of the Cuff Technique for Murine Heart Transplantation
Published on: June 26, 2020
Comparing short-term/long-term outcomes of heart transplants that occur inside and outside of normal working hours
Hidefumi Nishida1, Christopher Salerno1, David Onsager1
1Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA.
Insights
Heart transplant outcomes are similar regardless of whether surgeries occur during or after standard working hours. This indicates consistent quality of care for heart transplant recipients at all times.
Area of Science:
- Cardiology
- Transplant Surgery
- Healthcare Management
Background:
- Heart transplantation is a complex procedure with many logistical factors.
- Unpredictable circumstances necessitate heart transplants at any time of day.
Purpose of the Study:
- To investigate if heart transplant outcomes differ based on surgery timing (within vs. outside working hours).
Main Methods:
- Retrospective review of 329 heart transplant recipients (Jan 2010 - Jul 2020).
- Patients divided into 'working hours' (7:30-17:00) and 'after hours' (17:00-7:30) groups.
- Propensity score matching created 78 pairs for comparison of early/late clinical outcomes and survival.
Main Results:
- No significant differences in baseline characteristics between matched groups.
- In-hospital mortality, ischemic time, and cross-clamp time were comparable.
- Postoperative complications (stroke, graft dysfunction, re-exploration, dialysis) and long-term survival rates showed no significant variations.
Conclusions:
- Heart transplant timing (within or outside working hours) does not impact clinical outcomes.
- High-quality care is achievable for heart transplant patients regardless of the time of surgery.
Aims:
Heart transplantation involves many factors such as donor selection, recipient management, multidisciplinary assessment, coordination with other organ teams, and transportation. Because of some unpredictable factors, heart transplantation can be conducted at any time of day. The purpose of this study is to investigate if outcomes differ between heart transplants taking place inside or outside of normal working hours.
Methods And Results:
We reviewed patients who underwent heart transplantation at our institution from January 2010 to July 2020 (n = 329). Based on the documented start time of the recipient surgeries, the cohort was divided into two groups: working hours (Group A: 7:30 to 17:00; n = 92) and after hours (Group B: 17:00 to 7:30; n = 237). We compared these groups using propensity score matching analysis. After propensity score matching, 78 pairs of patients were successfully matched. We reviewed early and late clinical outcomes including survival. Long-term survival was compared using the Kaplan-Meier method. In the propensity-score matched patients, there were no significant differences in the baseline characteristics between two groups. In-hospital mortality was not significantly different between the two groups (Group A: 6.4% vs. Group B: 2.6%, P = 0.44). Ischaemic time and cross-clamp time did not differ between the groups. In terms of postoperative complications, there were no significant differences between two groups in stroke (6.4% vs. 3.9%, P = 0.72), primary graft dysfunction requiring extracorporeal membrane oxygenation (5.1% vs. 7.7%, P = 0.75), re-exploration for bleeding (9.0% vs. 12.8%, P = 0.44), and newly required haemodialysis (7.7% vs. 6.4%, P = 0.75). The survival rate in Group A (88.1% at 1 year, 81.3% at 3 years) was not significantly different from Group B (90.5% at 1 year, 82.3% at 3 years, log rank = 0.96).
Conclusion:
There was no significant difference in clinical outcomes between heart transplants taking place inside or outside of working hours. A high quality of care can be provided for heart transplant patients even during after hours.
