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Beating heart transplantation: A single center's initial experience and propensity-matched analysis against national
Ashley Y Choi1, Ntemena Kapula1, Hao He1
1Department of Cardiothoracic Surgery, Stanford University, Stanford, CA.
Insights
Beating heart transplantation (BHT) shows similar 30-day survival and improved 1-year graft survival compared to standard donation after circulatory death (DCD) heart transplants. This suggests BHT may offer better outcomes despite sicker recipients.
Area of Science:
- Cardiology
- Transplantation Surgery
- Immunology
Background:
- Beating heart transplantation (BHT) aims to minimize ischemia-reperfusion injury by avoiding cardioplegic arrest.
- Comparing BHT outcomes to standard donation after circulatory death (DCD) heart transplantation is crucial for clinical practice.
Purpose of the Study:
- To directly compare outcomes between the first cohort of BHT recipients and standard DCD recipients.
- To evaluate the impact of BHT on post-transplant survival and complications.
Main Methods:
- Retrospective analysis of UNOS registry data for adult DCD heart transplant recipients (12/2019-12/2023).
- Inclusion of adult BHT recipients from a single center (10/2022-9/2024).
- Nearest neighbor propensity-score matching to compare 30-day survival, mechanical support use, complications, length of stay, and 1-year survival.
Main Results:
- BHT recipients were sicker pre-transplant, requiring more pre-transplant support (IABP, ECMO) and having higher waitlist status.
- After matching, 30-day survival was similar between BHT (100%) and DCD (98.3%) recipients.
- One-year graft survival was significantly improved in BHT recipients (100%) compared to DCD recipients (83.9%).
Conclusions:
- Despite pre-transplant challenges, BHT demonstrated comparable early survival and superior 1-year graft survival versus standard DCD heart transplantation.
- BHT may offer excellent early post-transplant outcomes.
- Larger studies and longer follow-up are needed to confirm the long-term survival benefits of BHT.
Objective:
Beating heart transplantation (BHT) was adopted to avoid an additional episode of cardioplegic arrest and reperfusion and reduce allograft ischemia-reperfusion injury. We sought to establish a direct comparison of outcomes between the first cohort of BHT recipients at our center and standard DCD recipients across the US.
Methods:
The UNOS registry was queried to identify adult recipients who underwent first-time isolated DCD HT between 12/2019-12/2023 (before the first BHT was performed outside of our center). All adult patients who underwent first-time isolated DCD BHT between 10/2022-9/2024 at our center were included. Nearest neighbor propensity-score matching was performed and groups were compared for 30-day survival, need for post-transplant mechanical circulatory support, major complications, length of stay, and 1-year survival.
Results:
A total of 1083 standard DCD recipients and 31 BHT recipients were identified. Before matching, more BHT recipients required pre-transplant IABP (29% vs 9.8%, p=0.003) and ECMO (6.5% vs 0.7%, p=0.029), had higher status on the waitlist (Status 1-3; 97.5% vs. 62%, p<0.001), and spent fewer days waiting [7(5,14) vs 30(9149) days, p<0.001). After matching, BHT recipients demonstrated similar 30-day survival (100% vs 98.3%, p>0.9) and improved 1-year graft survival (100% vs 83.9%, p<0.001) compared to standard DCD recipients.
Conclusion:
Despite BHT recipients being sicker than standard DCD recipients pre-transplant, their matched survival at 30-days was similar and graft survival was improved at 1-year post-transplant. While BHT may confer excellent early post-transplant outcomes, a larger sample size and longer-term follow-up are needed to confirm the survival benefit associated with BHT.
