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Severe Postoperative Bleeding after Heart Transplantation
Alexandre Mansour1, Adrien Bougle2, Marion Turpin3
1Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Univ Rennes, CHU Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), Inserm, IRSET, UMR_S 1085, FHU SUPORT, F35000 Rennes, France.
Insights
Severe bleeding complications occur in 25% of heart transplant recipients, increasing one-year mortality. Mechanical cardiac support and cardiopulmonary bypass duration are key risk factors for post-transplant bleeding.
Area of Science:
- Cardiology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Post-operative bleeding is a common concern in cardiac surgery.
- However, its incidence, risk factors, and consequences after heart transplantation are not well-defined.
- Severe bleeding complications significantly impact patient outcomes.
Purpose of the Study:
- To determine the incidence of severe bleeding complications in adult heart transplant recipients.
- To identify risk factors associated with severe post-operative bleeding.
- To evaluate the impact of severe bleeding on one-year mortality.
Main Methods:
- An observational study was conducted on adult heart transplant patients from 2015-2022 in two French centers.
- Severe bleeding was defined using a Universal Definition of Perioperative Bleeding (UDPB) score ≥ 3.
- Multivariable logistic and Cox regression models were used to identify risk factors and assess mortality impact.
Main Results:
- Out of 446 patients, 112 (25%) experienced severe bleeding.
- Risk factors included long-term mechanical cardiac support, lower preoperative hemoglobin, and longer cardiopulmonary bypass (CPB) duration.
- Severe bleeding was linked to increased one-year mortality (35% vs. 13%, adjusted HR 1.91).
Conclusions:
- The incidence of severe hemorrhagic complications after heart transplantation is high, especially in patients with mechanical circulatory support.
- These bleeding events significantly increase patient morbidity and mortality.
- Further research is needed to develop effective prevention strategies for post-heart transplant bleeding.
Background:
Postoperative bleeding is frequent in cardiac surgery, but its incidence, risk factors, and consequences remain largely unknown after heart transplantation. The main objective of this study was to describe the incidence of severe bleeding complications after adult heart transplantation.
Methods:
The authors conducted an observational study including all adult patients who received a heart transplant between 2015 and 2022 in two French referral centers. The primary endpoint was the incidence of severe bleeding complications defined by a Universal Definition of Perioperative Bleeding score of 3 or greater. Multivariable logistic regression was used to identify variables associated with the incidence of severe postoperative bleeding. The impact of severe postoperative bleeding on 1-yr mortality was evaluated using a multivariable Cox regression model.
Results:
Among the 446 patients included, 112 (25%) developed severe bleeding. In multivariable analysis, long-term mechanical cardiac support (adjusted odds ratio [adjOR; 95% CI], 2.21 [1.01 to 4.88]), preoperative hemoglobin (adjOR, 0.85 [0.76 to 0.95]) and the duration of cardiopulmonary bypass (per 10-min increase; adjOR, 1.08 [1.03 to 1.15]) were associated with severe bleeding. Severe postoperative bleeding was associated with an increased mortality at 1 yr (35% vs. 13%; P < 0.001), with an adjusted hazard ratio of 1.91 (95% CI, 1.18 to 3.09; P = 0.008).
Conclusions:
This study reports a high incidence of severe hemorrhagic complications after heart transplantation, particularly in patients with mechanical circulatory support. Bleeding complications were associated with a significant increase in morbidity and mortality. Larger-scale studies are needed to identify and evaluate potential prevention strategies.
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