Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation
Marta Załęska-Kocięcka,
Marco Morosin,
Jonathan Dutton,
Rita Fernandez Garda,
Katarzyna Piotrowska,
Nicholas Lees,
Tuan-Chen Aw,
Diana Garcia Saez,
Ana Hurtado Doce
Affiliations
Marta Załęska-Kocięcka
Department of Mechanical Circulatory Support and Transplantation, National Institute of Cardiology, 04-628 Warsaw, Poland
Marco Morosin
Department of Anaesthesia and Critical Care, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6PY, UK
Jonathan Dutton
Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
Rita Fernandez Garda
Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
Katarzyna Piotrowska
Department of Quantitative Methods and Information Technology, Kozminsky University, 03-301 Warsaw, Poland
Nicholas Lees
Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
Tuan-Chen Aw
Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
Diana Garcia Saez
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6PY, UK
Ana Hurtado Doce
Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
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 p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23–1.71; p 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.
