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Inicio Cirugía Española (English Edition) Prognosis factors in heart-lung transplantation: 30 years experience in a refere...
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Vol. 102. Issue 1.
Pages 11-18 (January 2024)
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Vol. 102. Issue 1.
Pages 11-18 (January 2024)
Original article
Prognosis factors in heart-lung transplantation: 30 years experience in a reference center
Factores pronosticos en el trasplante cardiopulmonar: experiencia a 30 años en un centro de referencia
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Carlos Ordoñez Ochoaa,b, Jose Cerón Navarroa,b,
Corresponding author
ceron_jos@gva.es

Corresponding author.
, Olga Salamea Ávilac, Alilis Fontana Bellorína,b, Stephania Aguilar Gonzaleza,b, Alfonso Morcillo Aixeláa,b, Carlos Jorda Aragóna,b, Gabriel Sales Badiaa,b
a Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain
b Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
c Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain
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Tables (4)
Table 1. Demographic and preoperative characteristics.
Table 2. Donor characteristics.
Table 3. Factors associated with in-hospital mortality.
Table 4. Factors associated with survival.
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Abstract
Introduction

Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital.

Methods

We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan–Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method.

Results

A decrease in the number of procedures performed in the last decade was observed [2000−2009: 19 procedures (44.2%); 2010−2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010.

Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005).

Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005).

Conclusions

There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.

Keywords:
Pulmonary arterial hypertension
Heart-Lung transplantation
Congenital heart defect
Eisenmenger syndrome
Mortality
Survival
Abbreviations:
HLT
PH
IPH
CHD
ES
ECLS
Resumen
Introducción y objetivos

El trasplante cardiopulmonar ha presentado una disminución progresiva en el número de procedimientos. En nuestro país existe poca información al respecto, siendo el objetivo de este estudio analizar la experiencia de un hospital de referencia.

Métodos

Estudio Observacional unicéntrico de una cohorte histórica en el periodo entre 1990 y 2021. Las asociaciones entre categorías se evaluaron mediante la prueba de χ2 o la prueba exacta de Fisher. La supervivencia se analizó mediante el método de Kaplan–Meier. Las diferencias se evaluaron mediante el test de log-rank, el análisis multivariante con el método de Cox.

Resultados

Se observó una reducción del número de procedimientos realizados en el último decenio [2000−2009:19 procedimientos (44,2%); 2010−2021:15 procedimientos (34,8%)]. La mortalidad postoperatoria precoz fue del 23,3%, reduciéndose al 13,3% a partir del 2010. La intrahospitalaria fue del 41%, reduciéndose al 33% a partir del 2010.

Los factores asociados a la mortalidad: cirugía torácica previa, corticoterapia, circulación extracorpórea mayor a 200 minutos, tiempo de isquemia mayor a 300 minutos y dehiscencia traqueal (p < 0,005).

La supervivencia global al año, cinco y diez años fue del 58%, 44,7%, 36,1% respectivamente. Los factores asociados a menores tasas de supervivencia fueron cirugía torácica previa, donante masculino, circulación extracorpórea mayor 200 minutos, tiempo de isquemia mayor a 300 minutos, dehiscencia traqueal y diferencia de pesos. (p < 0,005).

Conclusiones

Existe una disminución en el numero de procedimientos, siendo mas evidente en la ultima década, pero evidenciando una mejora tanto de la mortalidad postoperatoria y supervivencia.

Palabras clave:
Trasplante de corazón-pulmón
Hipertensión arterial pulmonar
Cardiopatías congénitas
Síndrome de eisenmenger
Mortalidad
Supervivencia

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