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Heart transplantation after cardioverter-defibrillator implantation. A case control study
R J Novick1, A H Menkis, G M Guiraudon
1Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
Insights
Implantable cardioverter-defibrillator (ICD) insertion does not increase risks for heart transplant recipients. This study found similar outcomes for patients who received an ICD before heart transplantation compared to those who had prior cardiac surgery.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening ventricular arrhythmias.
- The impact of prior ICD implantation on outcomes following heart transplantation requires investigation.
Purpose of the Study:
- To determine if previous ICD insertion adversely affects outcomes after heart transplantation.
- To assess the safety and feasibility of ICD use in patients awaiting heart transplantation.
Main Methods:
- A case-control study comparing six heart transplant recipients with prior ICD insertion to six matched controls.
- Matching criteria included age, preoperative status, hemodynamics, transplantation date, graft ischemic time, prior cardiac surgery history, and follow-up duration.
Main Results:
- No significant differences were observed in operating room time, chest tube drainage, extubation time, or ICU/hospital stay duration.
- Transfusion requirements (packed cells, plasma, platelets, cryoprecipitate) were similar between groups.
- Rates of rejection episodes and infectious complications within 90 days post-transplant were identical.
Conclusions:
- Heart transplantation following ICD implantation does not appear to carry higher risks compared to transplantation after previous cardiac operations.
- This study supports the potential utility of ICDs for patients with ventricular dysrhythmias awaiting heart transplantation.
Abstract:
A case control study was performed to determine whether previous implantable cardioverter-defibrillator (ICD) insertion adversely affects outcome after heart transplantation. Six male heart transplant recipients who had undergone ICD insertion 12 +/- 5 months before heart transplantation were compared to a cohort of six heart transplant recipients who were matched according to age, preoperative status and hemodynamics, date of transplantation, graft ischemic time, history of a previous cardiac operation, and duration of follow-up. There were no significant differences in operating room time, chest tube drainage, time to extubation, and the duration of intensive care unit or hospital stay between the two groups. Furthermore, there were no significant differences in the number of units of packed cells, fresh frozen plasma, platelets and cryoprecipitate transfused. The number of treated rejection episodes and the number of patients requiring intravenous antibiotics for infection in the first 90 days was identical between groups. It was concluded that heart transplantation after ICD implantation did not appear to carry more risk than heart transplantation after a previous cardiac operation. Our limited experience supports the potential use of the ICD in patients with life-threatening ventricular dysrhythmias who are awaiting transplantation.