THE RESULTS OF HEART TRANSPLANTATION DEPENDING ON THE SEVERITY OF THE LEFT VENTRICULAR MYOCARDIAL HYPERTROPHY OF THE DONOR HEART
Authors:   Republican Scientific and Practical Center Cardiology, S.V. Spiridonov , D.S. Tretyakov ,   Republican Scientific and Practical Center Cardiology, P.E. Bulavskaya ,   Belarusian State Medical University, A.V. Valentyukevich ,   Republican Scientific and Practical Center Cardiology, T.A. Dubovik ,   Republican Scientific and Practical Center Cardiology, N.V. Mankevich ,   Republican Scientific and Practical Center Cardiology, Yu.P. Ostrovsky ,   Republican Scientific and Practical Center Cardiology
Published: February 2022

Objective. To evaluate the influence of donor LV hypertrophy on the survival of recipients after heart transplantation (HTx). Methods: The study included 446 patients who underwent orthotopic heart transplantation using the biatrial or bicaval technique in the period from 2009 to 2021. The study had a retrospective single-center cohort design. LV hypertrophy was assessed according to ECHO CG data, focusing on measuring the thickness of the walls of the donor heart according to the recommendations of the Ame- rican Society of Echocardiography: < 1.1 – no hypertrophy, 1.1–1.3 cm – mild, 1.4–1.6 cm – moderate LVH, ≥ 1.7 – severe. Control echocardiograms were performed immediately after HTx and 1 year later. According to the above criteria, the first group included recipients of donor heart without LVH and with in- significant LVH, the second group consisted recipients of heart with mod- erate and severe LVH. For a more detailed analysis of survival, 4 subgroups were subsequently identified: no LVH, insignificant, moderate and severe LVH. We analyzed the overall postoperative survival in groups/subgroups, as well as the thickness of IVS and GS in dynamics (after 1 year). The influence of the donor’s age (threshold age 45 years) and ischemia time (threshold – 240 min) of the donor heart on the results of using donor hearts with LVH was also investigated, due to this the corresponding subgroups were identified. Results. In the analysis of survival, no significant differences were found between the group of recipients who received a heart without hypertrophy or with insignificant LVH and the group of recipients who received an organ with moderate or severe LVH. Expanded survival analyzes also showed no significant differences between subgroups (p = 0.792). In the present study, the survival rate of heart recipients with LVH did not depend on the time of ischemia, but a significant decrease in the survival rate of heart recipients with LVH from donors older than 45 years was obtained (p = 0.035), while in the group with no or insignificant LVH, the donor age did not affect the HTx result. One year after TS a significant decrease in the thickness of both IVS (14.9 → 12.1) and PW (12.78 → 10.52) has been recorded. Conclusion. Heart transplantation with left ventricular myocardial hypertrophy (up to 17 mm) does not affect the survival of recipients (log-rank: p = 0.7), provided that the donor’s age is less than 45 years old, while over time, in the vast majority of cases, there is a regression of wall thickness left ventricular myocardium, which allows us to consider the use of heart transplantation with LVH as one of the options for expanding the pool of donor organs. Further studies of the effect of severe LVH with wall thickness greater than 1.7 cm using a larger sample are needed.