Abstract 19146: Increasing Donor Age is a Risk Factor for Permanent Pacing After Orthotopic Heart Transplantation
Introduction: Due to extreme scarcity of donor hearts in The Netherlands, increasingly older and marginal donor hearts are accepted for orthotopic heart transplantation (HTx). We evaluated the relationship between the age of the donor and the need for pacemaker (PM) implantation early or late after HTx.
Methods: The demographic and clinical data of all consecutive patients transplanted between 1984 until 2014 at our center were analyzed (n=612, 74% male; median follow up of 97 months [IQR 38-161]). Three groups were created based on donor age: Group I (0-35 y, n=345), Group II (35-50 y, n=190) and Group III (>50 y, n=77). The primary outcome was permanent PM implantation after HTx for either sinus node dysfunction (SND) or AV block (AVD). The need for early (90 days) was evaluated. The following secondary parameters were analyzed: recipient age, ischemic time, and death.
Results: The mean recipient age at HTx was 46.4 ± 14.3 years [range 2-72 y] and donor age 32.8 ± 13.7 y. Significant older donor hearts were transplanted during the last ten years compared to the first ten years (40.1±15.9 y vs. 25.7±8.3 y, p<0.001) and more early PMs were implanted (10.2% vs. 1.7%, p<0.001). Ischemic time (176±45 min vs. 181±48 min vs. 186±48 min, p=ns, respectively) was comparable for group I, II and III. Overall 11.3% (SND, n=31; AVB, n=38) received a PM after a median period of 10.6 months [IQR 1.3-94 months]. In group III a higher amount of early PM were implanted (11.7%, n=9) compared to group I (2.0%, n=7; p=0.001). For late PM implant equal rates were observed (6.5% vs. 6.4%, p=ns, respectively). In total 55% (n=342) died during follow up. The 10-year survival rate was 61%.
Conclusions: Increasing donor age, particularly > 50 years, is a major risk factor for the need of permanent pacing post-HTx.
Author Disclosures: F. Akca: None. T. Szili-Torok: None. R. Muslem: None. O. Manintveld: None. A. Constantinescu: None. O. Birim: None. K. Caliskan: None.
- © 2014 by American Heart Association, Inc.