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Heart Transplantation Outcomes in Patients With Hypertrophic Cardiomyopathy in the Era of Mechanical Circulatory

Matylda Mazur1, Robert Dowling2, Geetha Bhat2

  • 1From the Department of Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 12, 2024
PubMed

Insights

Mechanical circulatory support use increased for hypertrophic cardiomyopathy (HCM) patients awaiting heart transplantation (HT). Despite more ICU admissions, pre-HT status improved, with stable, favorable post-HT survival rates.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Mechanical Circulatory Support

Background:

  • Mechanical circulatory support (MCS) is crucial for heart transplantation (HT) candidates.
  • The impact of MCS on hypertrophic cardiomyopathy (HCM) patients undergoing HT is not well understood.

Purpose of the Study:

  • To evaluate changes in characteristics and post-HT outcomes for HCM patients over time.
  • To compare HCM patients with nonischemic (NICM) and ischemic cardiomyopathy (ICM) recipients.

Main Methods:

  • Retrospective cohort study of adult HT recipients (1998-2017) from the ISHLT registry.
  • Analysis divided into two eras: 1998-2007 and 2008-2017.
  • Comparison of HCM patients across eras and against NICM and ICM patients within each era.

Main Results:

  • Heart transplantation for HCM patients increased by 63% across eras.
  • HCM recipients showed increased ICU admissions with intra-aortic balloon pump (IABP) support but improved pre-HT functional status.
  • Post-HT survival remained favorable and unchanged; in the later era, HCM patients were more often in the ICU and on inotropes at HT, with improved survival compared to ICM.

Conclusions:

  • Despite increased critical care needs, HCM patients demonstrate improved pre-transplant status and sustained favorable post-transplant survival.
  • HCM patients represent a growing proportion of HT recipients, with outcomes comparable to NICM and better than ICM.
  • MCS strategies and patient selection for HCM in HT warrant continued investigation.

Keywords:
heart transplantationhypertrophic cardiomyopathymechanical circulatory support

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