Background:

Total artificial heart (TAH) is used as a bridge to heart transplantation in patients with end-stage biventricular failure. Anemia requiring blood transfusions occurs following TAH implantation. Early anemia within 7 days of device implantation results from perioperative bleeding. Late anemia beyond 7 days of surgery is associated with hemolysis, inflammation and inadequate hematopoiesis. The impact of transfusion requirements on mortality and likelihood of heart transplantation is unknown.

Methods:

We retrospectively reviewed data on all patients implanted with TAH at our institution between April 2006 and December 2014 (n=81). Odds of death versus heart transplantation for each additional early or late transfusion were calculated using logistic regression models. A second model controlled for baseline characteristics (gender, age, ethnicity, body surface area) and comorbidities (etiology of cardiomyopathy, history of hypertension, dyslipidemia, diabetes, atrial fibrillation, peripheral vascular disease, cerebrovascular event, thromboembolism). For late transfusions, total time on TAH support was included as an additional covariate.

Results:

Of the 81 patients implanted with TAH, 67 (82.7%) were successfully bridged to heart transplantation. The mean age was 46.6 years (SD 12.2). The patients were 12.3% female and 87.7% male. The average preoperative hematocrit was 32.2 % (SD 6.4). Patients received a median of 9 units total transfusions (range 0-92), 4 units early transfusions (range 0-33), and 3 units late transfusions (range 0-70).

For early blood transfusions, the odds of death before heart transplant increased by a factor of 1.127 for each additional unit of blood (p=0.007) and 1.168 (p=0.012) when controlling for baseline characteristics and comorbidities. For late transfusions, the odds of death increased by a factor of 1.036 for each unit of blood (p=0.099) and 1.038 (p=0.099) when controlling for time on TAH support. When controlling for baseline characteristics, comorbidities, and time, the odds of death increased by 1.049 (p=0.063).

Conclusion:

While early blood transfusions following TAH implantation was associated with an increased risk of death prior to heart transplantation, similar findings were not observed for late blood transfusions. Thus, poor prognosis was associated with perioperative bleeding, but not with TAH induced chronic anemia.

CITATION INFORMATION: Cook J, Kang L, Flattery M, Tchoukina I. Impact of Transfusion Requirements on Likelihood of Heart Transplantation After Total Artificial Heart. Am J Transplant. 2016;16 (suppl 3).

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