Background
The use of mechanical circulatory support (MCS) devices in heart transplant cases has been growing over the years, serving as a bridge to transplantation for those awaiting for a suitable donor heart. Despite the increased utilization, comprehensive data on MCS outcome in heart transplant patients remains limited.
Methods
A retrospective analysis was conducted using data from the Nationwide Inpatient Sample spanning from 2016 to 2019. Adult patients (age >18 years) who underwent heart transplant were identified using ICD-10-CM diagnosis and procedure codes. Patients who received MCS were identified. National estimates were derived using discharge-level weight analysis. Univariate and multivariable hierarchical regression analyses were used to determine the odds ratios (ORs).
Results
Between 2016 and 2019, a total of 11,300 patients underwent heart transplant. Among them, 3,085 (27.3%) received MCS, with its utilization increasing annually from 525, 515, 645 and 1,400 cases in 2016, 2017, 2018 and 2019 (p<0.0001) respectively. Both groups-those with and without MCS had comparable proportions of females (28.0% vs 28.4%) and mean ages (54.1 years vs 53.4 years). However, patients with MCS were more likely to of African American (26.1% vs 21.1%) and less co-morbidities including diabetes mellitus (26.3% vs 33.5%) and chronic kidney disease (22.0% vs 25.4%).In MCS group, there were higher rates of in-hospital mortality (12.8% vs 2.9%), cardiogenic shock (75.&% vs 37.7%), ischemic stroke (4.9% vs 3.2%), hemorrhagic stroke (3.1% vs 1.0%) and lower requirement for blood transfusion (13.1% vs 19.2%). The cost of hospitalization is higher in MCS group ($1,322,352 vs $877,340.7) and the mean cost of each MCS patient was $1,476,950.
Conclusions
There has been a yearly rise in the usage of MCS in heart transplants, with a significant surge observed in 2019 following the 2018 UNOS heart allocation policy revision. This increased was accompanied by increased rates of in-hospital mortality and post-procedural complications.