10-year experience in orthotopic heart transplantation in Kuzbass

Background. Orthotopic heart transplantation (OHT) is the gold standard treatment for individuals with endstage heart failure (HF), providing the best survival and quality of life. In Russia, the number of OHT procedures and transplantation of other organs have significantly increased in recent years. At the same time, there is lower perioperative mortality and higher survival in the post-OHT long-period.

Objective: to analyze OHT outcomes in Kuzbass over a 10-year period.

Material and methods. From January 2013 to December 2023, 72 OHTs (36.7% of those included on the heart transplant waiting list (HTWL) over a 10-year period) were performed at the Research Institute for Complex Issues of Cardiovascular Diseases. Recipient median age was 56 [50.5; 61.0] years, which included 61 men and 11 women. Among the etiologic causes of end-stage HF, ischemic cardiomyopathy was predominant in 65.3% (n = 47) of recipients, whereas dilated cardiomyopathy was present in 25% (n = 18) of recipients. Other cardiomyopathies accounted for 9.7% (n = 7).

Results. A total of 196 patients with end-stage HF were included in the HTWL over a 10-year period; 74 (37.8%) of these did not live to get a transplant. The waitlist time was 173 days (5.77 months) – which is slightly longer than the average waiting time of 3.9 months for OHT according to data from European registries. Waitlist mortality was 19.6%. The 10-year average in-hospital mortality rates among patients after OHT were 16.7% and 1-year mortality was 15.3%. These rates are consistent with worldwide trends for this high-tech medical care. Cumulative survival at the end of 2023 was 51.4% (36 patients after OHT). Median length of stay in the hospital was 28 days, with 14 days spent in the intensive care unit. Donor heart anoxia time was 112 [85.25; 170.5] minutes, and cardiopulmonary bypass time was 145 [124; 169.5] minutes. Ten patients (13.9%) required extracorporeal membrane oxygenation, while 8.3% of cases required extracorporeal homeostasis correction.

Conclusion. The 10 years of successful experience at the Research Institute for Complex Issues of Cardiovascular Diseases validates the need to develop the OHT program in Kuzbass as a gold standard for treating end-stage HF.

1. Shahim B, Kapelios CJ, Savarese G, Lund LH. Global Public Health Burden of Heart Failure: An Updated Review. Card Fail Rev. 2023; 9: e11. doi: 10.15420/cfr.2023.05.

2. Okunev IM, Kochergina AM, Kashtalap VV. Chronic and acute decompensated heart failure: topical issues. Complex Issues of Cardiovascular Diseases. 2022; 11 (2): 184–195. [In Russ, English abstract]. https://doi.org/10.17802/2306-1278-2022-11-2184-195.

3. Aissaoui N, Morshuis M, Maoulida H, Salem JE, Lebreton G, Brunn M et al. Management of end-stage heart failure patients with or without ventricular assist device: an observational comparison of clinical and economic outcomes. Eur J Cardiothorac Surg. 2018; 53 (1): 170– 177. doi: 10.1093/ejcts/ezx258.

4. Poptsov VN. Heart transplantation: an anesthesiologist-anesthesiologist-animatologist’s point of view. M.– Tver’: Triada, 2022; 440.

5. Bounader K, Flécher E. End-stage heart failure: The future of heart transplant and artificial heart. Presse Med. 2023; 53 (1): 104191. doi: 10.1016/j.lpm.2023.104191.

6. Nesseler N, Mansour A, Bernard C, Coutance G, Bouglé A. Perioperative management of heart transplantation: a clinical review. Anesthesiology. 2023; 139: 493– 510. doi: 10.1097/ALN.0000000000004627.

7. Dren’ EV, Sogojan NK, Ljapina IN, Golubovskaja DP, Pecherina TB, Barbarash OL. Clinical case of a patient with extreme hypertrophic cardiomyopathy and recurrent idiopathic transudative pericardial effusion. Complex Issues of Cardiovascular Diseases. 2023; 12 (3): 126–135. [In Russ, English abstract]. doi: 10.17802/2306-1278-2023-12-3-126-135.

8. Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich EM et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult heart transplantation report – 2019; focus theme: donor and recipient size match. J Heart Lung Transplant. 2019; 38: 1056–1066. doi: 10.1016/j.healun.2019.08.004.

9. Order of the Ministry of Health of the Russian Federation from 09.01.2023 № 3n «On approval of the standard of medical care for adults in heart transplantation».

10. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2022. 15th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2023; 25 (3): 8–30. [In Russ, English abstract]. https://doi.org/10.15825/1995-1191-2023-3-8-30.

11. Heart transplantation, presence of a transplanted heart, heart graft dieoff and rejection – Recommendations of the Ministry of Health of the Russian Federation 2020.

12. Heart transplantation, presence of a transplanted heart, heart graft dieoff and rejection – Recommendations of the Ministry of Health of the Russian Federation 2023.

13. Cantrelle C, Legeai C, Latouche A, Tuppin Ph, Jasseron C, Sebbaget L et al. Access to heart transplantation: a proper analysis of the competing risks of death and transplantation is required to optimize graft allocation. Transplant Direct. 2017; 3: e198. doi: 10.1097/TXD.0000000000000711.

14. Hsich EM, Blackstone EH, Thuita LW, McNamara DM, Rogers JG, Yancy CW et al. Heart Transplantation: An In-Depth Survival Analysis. JASS Heart Fail. 2020; 8 (7): 557–568. doi: 10.1016/j.jchf.2020.03.014.

15. Cantrelle C, Dorent R, Legeai C, Damy Th, Bastien O, Tuppin Ph et al. Hospitalisation and life support in the year before and during heart transplantation: a French national study. Open Heart. 2018; 5: e000913. doi: 10.1136/openhrt-2018-000913.

16. Pecherina T, Kutikhin A, Kashtalap V, Karetnikova V, Gruzdeva O, Hryachkova O et al. Serum and echocardiographic markers may synergistically predict adverse cardiac remodeling after st-segment elevation myocardial infarction in patients with preserved ejection fraction. Diagnostics. 2020; 10 (5): 301. doi: 10.3390/diagnostics10050301.

17. Barbarash OL, Rejtblat OM, Korennova OYu, Efremushkina AA, Ustyugov SA, Hramcova NA et al. Resolution on the results of the council of experts: «Improving the system of medical care for patients with cardiovascular diseases in the siberian and far eastern federal districts within the framework of the federal project «Combating cardiovascular diseases». Focus on CHF». Complex Issues of Cardiovascular Diseases. 2023; 12 (4S): 206–209. (In Russ.). doi: 10.17802/2306-1278-2023-12-4s-206-209.

18. Zamperetti N, Bellomo R, Piccinni P, Roncoet С. Reflections on transplantation waiting lists. Lancet. 2011; 378: 632–635. doi: 10.1016/S0140-6736(10)62343-4.

19. Chernyavskiy AM, Doronin DV, Fomichev AV, Osipov DE, Shmyrev VA, Karaskov AM. 10-year heart transplantation experience in Novosibirsk. Russian Journal of Transplantology and Artificial Organs. 2018; 20 (1): 23–31. [In Russ, English abstract]. doi: 10.15825/1995-1191-2018-1-23-31.

20. Khubutiya MSh, Sokolov VV, Redkoborodyy AV, Kozlov IA, Timerbaev VKh, Khutsishvili LG et al. The experience of 70 heart transplants in a multidisciplinary medical care facility. Transplantologiya. The Russian Journal of Transplantation. 2018; 10 (3): 197–206. [In Russ, English abstract]. doi: 10.23873/2074-05062018-10-3-197-206.

21. Tkhatl LK, Tatarintseva ZG, Kosmacheva ED. Difficulties in diagnosing and predicting possible complications in patients after heart transplantation: singlecenter experience in the Krasnodar region. Russian Journal of Cardiology. 2024; 29 (2): 55–58. [In Russ, English abstract]. doi: 10.15829/1560-4071-2024-5558.

22. Trivedi J, Siddharth P, Rabkin D, Gallo M, Guglin M, Slaughter MS et al. Predictors of Survival After Heart Transplant in the New Allocation System: A UNOS Database Analysis. ASAIO J. 2024; 70 (2): 124–130. doi: 10.1097/MAT.0000000000002070.

23. Tanveer Y, Arif A, Tsenteradze T, Anika NN, Bakht D, Masood QF et al. Revolutionizing Heart Transplantation: A Multidisciplinary Approach to Xenotransplantation, Immunosuppression, Regenerative Medicine, Artificial Intelligence, and Economic Sustainability. Cureus. 2023; 15 (9): e46176. doi: 10.7759/cureus.46176.