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. 2024 Nov 3;60(11):1801.
doi: 10.3390/medicina60111801.

The Impact of Heart Failure Chronic Treatment Prior to Cardiac Transplantation on Early Outcomes

Dragos-Florin Baba  1   2 , Horatiu Suciu  2   3 , Calin Avram  4 , Marius Mihai Harpa  2   3 , Mircea Stoian  5   6 , Diana-Andreea Moldovan  2   7 , Laurentiu Huma  1   2 , Gabriel Rusu  2 , Tunde Pal  8 , Alina Danilesco  6 , Adina Stoian  9 , Anca-Ileana Sin  1
Affiliations

The Impact of Heart Failure Chronic Treatment Prior to Cardiac Transplantation on Early Outcomes

Dragos-Florin Baba et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Cardiac transplantation represents the option for patients with end-stage heart failure (HF), providing the best survival rate. However, the postoperative complications of transplant patients remain a challenge for clinicians. The objective of our study was to evaluate the effect of preoperative chronic HF treatment on the occurrence of in-hospital complications. Materials and Methods: We retrospectively included a total of 50 patients who underwent cardiac transplantation between January 2011 and December 2023 from the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures. We correlated the preoperative chronic HF treatment with the postoperative complications by Spearmen's correlation coefficient, respectively. With logistic regression, the associations between the treatment and specific complications were determined. Results: Significant negative correlations were found between Carvedilol treatment with 2-month mortality (r = -0.30; 95% CI: -0.53--0.02; p = 0.03), Ramipril with hospital stay (r = -0.38; 95% CI: -0.60--0.12; p < 0.01) and intensive care unit (ICU) stay (r = -0.37; 95% CI: -0.59--0.11; p = 0.01), and Spironolactone usage with hospitalization duration (r = -0.28; 95% CI: -0.52--0.01; p = 0.04). Furthermore, Carvedilol treatment represented a protective factor against early acute kidney injury (AKI) (OR: 0.22; 95% CI: 0.05-0.91; p = 0.03). Spironolactone treatment was a protective factor against AGR (OR: 0.12; 95% CI: 0.02-0.66; p = 0.01) treatment, in contrast to angiotensin-converting enzyme inhibitor (ACEI) therapy (OR: 5.30; 95% CI: 1.03-27.17; p = 0.04). Conclusions: Pre-transplant Carvedilol treatment was negatively correlated with the 2-month mortality rate. Ramipril and Spironolactone therapy were negatively correlated with hospitalization duration, and Ramipril was additionally correlated with ICU stay. Moreover, Carvedilol therapy represented a protective factor against early AKI. Pre-transplant Spironolactone was associated with lower event rates of AGR, in contrast to ACEI treatment. Prospective studies with larger cohorts are needed in order to draw drastic conclusions.

Keywords: Carvedilol; Ramipril; Spironolactone; cardiac transplantation; complications; mortality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study design.
See this image and copyright information in PMC

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