Evaluating Biventricular Myocardial Velocity and Interventricular Dyssynchrony in Adult Patients During the First Year After Heart Transplantation

Introduction : Single institution series have suggested that donor-recipient gender matching may be an important factor influencing survival following orthotopic heart transplantation (OHT). The United Network for Organ Sharing (UNOS) database provides a unique and novel opportunity to address this issue by examining outcomes based on gender pairing for a large cohort of OHT patients. Methods : We retrospectively reviewed the UNOS dataset to identify 18,240 patients receiving first time OHT between the years 1998 and 2007. Stratification was by both donor and recipient gender so that 4 separate groups were created (male donor with male recipient, female donor with male recipient, male donor with female recipient, and female donor with female recipient). The primary endpoint of all cause mortality was compared between groups using a Cox proportional hazard regression model. Secondary outcomes (thirty day and one year mortality and rejection during the first year) were examined with multiple logistic regression. Post transplant survival was modeled via the Kaplan Meier method. Results : Of 18,240 patients, 12,951 (71%) were matched by gender to their donor (77% for male recipients, n= 10,750 and 51% for female recipients n= 2,201). A total of 4,543 patients died during the study period (25%). Donor-recipient gender matching resulted in a reduction in the risk of adjusted cumulative mortality (Hz ratio 0.86 [0.78–0.95], p= 0.003) and the greatest risk for cumulative mortality occurred when pairing a male donor with a female recipient (Hz ratio 1.2 [1.04–1.37], p= 0.01). Thirty day and one year mortality were also significantly decreased by gender pairing (OR 0.75 [0.61–0.95], p= 0.02 for 30 day mortality, and OR 0.8 [0.68–0.93], p= 0.005 for one year mortality). Gender pairing resulted in a 13% decrease in the risk of graft rejection within the first year (OR 0.87 [0.79–0.98], p= 0.02]. Kaplan Meier survival modeling revealed that the greatest cumulative survival occurred when a male recipient received an organ from a male donor (Figure) Conclusions : The UNOS dataset has provided a large sample examining donor recipient gender pairing in OHT. Recipients who receive organs for same sex donors have significantly improved short and long term survival.

Download Full-text

1238 Central sleep apnea with Cheyne Stokes breathing in a pediatric patient with heart failure

SLEEP ◽

10.1093/sleep/zsaa056.1232 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A472-A472

Author(s):

Weston T Powell ◽

Maida Chen ◽

Erin MacKintosh

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Heart Transplantation ◽

Dilated Cardiomyopathy ◽

Acute Heart Failure ◽

Pediatric Patient ◽

Central Sleep Apnea ◽

Supplemental Oxygen ◽

Adult Patients ◽

Cheyne Stokes Breathing

Abstract Introduction Central sleep apnea due to Cheyne-Stokes breathing (CSA-CSB) commonly occurs in adult patients with chronic heart failure, but has rarely been described in children. We describe a case of CSA-CSB in a pediatric patient with dilated cardiomyopathy and acute heart failure. Report of Case A 12-year-old is admitted to the intensive care unit in the setting of new diagnosis of dilated cardiomyopathy leading to acute systolic and diastolic heart failure requiring inotropic infusions. After admission she is noted to have self-resolving desaturations on continuous pulse oximetry while asleep. Sleep medicine is consulted for further evaluation. She has desaturations during naps and night-time sleep that are not associated with any snoring, congestion, cough, choking, or gagging. She underwent adenotonsillectomy 7 years prior. Her father has dilated cardiomyopathy. Current medications are spironolactone, furosemide, ranitidine, loratadine, enoxaparin, milrinone and epinephrine infusion. Physical exam reveals an obese girl with absent tonsils, clear breath sounds, and tachycardia. Cardiac MRI showed severely dilated left ventricle with global hypokinesia and depressed function (EF 7%). Polysomnography reveals AHI 24.2/hr, with oAHI 0/hr and cAHI 24.2/hr. No snoring, flow limitation, or thoracoabdominal paradox is seen. Cheyne-Stokes respiration is present leading to diagnosis of CSA-CSB. Supplemental oxygen is provided to blunt desaturations. While waiting for titration PSG she underwent placement of a left ventricular assist device and orthotopic heart transplantation. Following heart transplantation she had resolution of desaturations while asleep without supplemental oxygen; family declined repeat polysomnography. Conclusion Central sleep apnea with Cheyne-Stokes breathing is associated with increased mortality in adult patients with heart failure and provides important prognostic information if identified. The prevalence of central sleep apnea and its implications are unknown in pediatric patients and our case highlights the need to consider sleep disordered breathing as a cause of desaturations in patients with acute heart failure.

Download Full-text