title: [Preoperative and intraoperative risk factors affecting mortality after heart transplantation: a single-center experience].
abstract: OBJECTIVE
  We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center.
  
  
  METHODS
  Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis.
  
  
  RESULTS
  Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality.
  
  
  CONCLUSIONS
  Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation.
authors.affiliation: Ege Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye. drgungorhasan@yahoo.com
authors.forename: Hasan
authors.initials: H
authors.lastname: Güngör
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Ayık
authors.forename: Sanem
authors.initials: S
authors.lastname: Nalbantgil
authors.forename: Serkan
authors.initials: S
authors.lastname: Ertugay
authors.forename: Cağatay
authors.initials: C
authors.lastname: Engin
authors.forename: Tahir
authors.initials: T
authors.lastname: Yağdı
authors.forename: Mehdi
authors.initials: M
authors.lastname: Zoghi
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007239:Infections / Q000401:mortality; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D018497:Ventricular Dysfunction, Right / Q000401:mortality