Readmission Rates and Outcomes at 90 Days in Patients with Perioperative Use of Temporary Circulatory Support at the Time of Heart Transplantation
Hernandez GA, Lemor A, Blumer V, Chaparro S, Zalawadiya S, Cowger J, and Lindenfeld J. Readmission Rates and Outcomes at 90 Days in Patients with Perioperative Use of Temporary Circulatory Support at the Time of Heart Transplantation. J Heart Lung Transplant 2019; 38(4 Suppl):S444.
J Heart Lung Transplant
Purpose: Temporary circulatory support (TCS) devices are an important tool for the treatment of cardiogenic shock and/or end-stage HF patients. With its increased use as bridge to heart transplant (HT) or for early support in graft failure, we sought to evaluate readmission rates and outcomes derived after the index admission of HT. Methods: Using the national readmission database (NRD), a resource of the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases, we examined discharge data from 2010 until 2014 and identified all patients age 18 years and older who underwent heart transplant with or without preopTCS. The primary outcome was 90-day readmission. Multivariable logistic regression was used to compare in-hospital outcomes between groups. Results: We identified 7,015 patients discharged after HT of which 11.1% (778) received perioperative TCS support; Baseline characteristics during index admission are shown in table 1. Overall, there was a non-significant trend towards lower readmission for those with TCS compared to the non-TCS cohort (6.9% vs. 14.4% p= 0.069 for 30-day and 22.7%vs 30.1% p=0.077for 90-day readmissions). There were no differences in readmission mortality (1.1% vs. 1% p=0.95), cost ($22,659 vs $20,060 p=0.056), length of stay (7.2 days SD 11.2 vs 5.5 days SD 5.9 p=0.098), stroke (1.2% vs. 1.3% p=0.96) or major bleeding (1.3% vs. 1.1% p=0.83). Readmissions for cardiac related complications were 0% in the TCS group and 5% in those without MCS. Patients supported with ECMO during index admission had higher mortality during readmission compared to other MCS (7.2% vs. 0.9% p=0.020). Conclusion: Patients supported with ECMO prior to HT had high long-term mortality. Otherwise, TCS appears to be a safe option in patients requiring support prior to HT without increased risks of readmission, stroke or 90-day mortality.