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. 2024 Apr 20;14(8):851.
doi: 10.3390/diagnostics14080851.

Advanced Respiratory Failure Requiring Tracheostomy-A Marker of Unfavourable Prognosis after Heart Transplantation

Marta Załęska-Kocięcka  1   2 , Marco Morosin  3 , Jonathan Dutton  2 , Rita Fernandez Garda  2 , Katarzyna Piotrowska  4 , Nicholas Lees  2 , Tuan-Chen Aw  2 , Diana Garcia Saez  5 , Ana Hurtado Doce  2
Affiliations

Advanced Respiratory Failure Requiring Tracheostomy-A Marker of Unfavourable Prognosis after Heart Transplantation

Marta Załęska-Kocięcka et al. Diagnostics (Basel). .

Abstract

Advanced respiratory failure with tracheostomy requirement is common in heart recipients. The aim of the study is to assess the tracheostomy rate after orthotopic heart transplantation and identify the subgroups of patients with the highest need for tracheostomy and these groups' association with mortality at a single centre through a retrospective analysis of 140 consecutive patients transplanted between December 2012 and July 2018. As many as 28.6% heart recipients suffered from advanced respiratory failure with a need for tracheostomy that was performed after a median time of 11.5 days post-transplant. Tracheostomy was associated with a history of stroke (OR 3.4; 95% CI) 1.32-8.86; p = 0.012), previous sternotomy (OR 2.5; 95% CI 1.18-5.32; p = 0.017), longer cardiopulmonary bypass time (OR 1.01; 95% CI 1.00-1.01; p = 0.007) as well as primary graft failure (OR 6.79; 95% CI2.93-15.71; p < 0.001), need of renal replacement therapy (OR 19.2; 95% 2.53-146; p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23-1.71; p < 0.01). One-year mortality was significantly higher in patients requiring a tracheostomy vs. those not requiring one during their hospital stay (50% vs. 16%, p < 0.001). The need for tracheostomy in heart transplant recipients was 30% in our study. Advanced respiratory failure was associated with over 3-fold greater 1-year mortality. Thus, tracheostomy placement may be regarded as a marker of unfavourable prognosis.

Keywords: ex vivo perfusion; heart transplantation; tracheostomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of patients included in the study.
Figure 2
Figure 2
Survival probability of heart transplant patients with and without tracheostomy.
Figure 3
Figure 3
Survival probability of early (<14 days) vs. late (≥14 days) trachesotomy recipients among heart transplant patients.
See this image and copyright information in PMC

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