Heart transplantation (HT) increases at some centers each year and decreases at others. We examined characteristics of patients having HT at the same hospital in 2 different time periods (1997–2012 and 2013–2015) by 2 different surgical groups. We compared certain clinical and morphological finding in 291 patients having HT 1997 to 2012 to finding in 228 other patients having HT from 2013 to 2015. Several significant (p <0.05) differences were found: in the most recent time period (2013–2015) compared to the earlier time period (1997–2012), the mean ages of the men were older (57 years -vs- 55 years); diabetes mellitus was more frequent (37% -vs- 21%); systemic hypertension (by history) was more frequent (59% -vs- 32%); the mean body mass index was higher (29.2 kg/m 2 -vs- 26.5 kg/m 2 ), and mean heart weight was lower in both men (509 g -vs- 549 g) and women (422 g -vs- 454 g). There were insignificant (p >0.05) differences in gender, frequency of massive cardiac adiposity, underlying cardiac condition, frequency of coronary heart disease, and frequency of previous insertion of a left ventricular assist device. In conclusion, certain characteristics of patients having HT at one Texas hospital changed in several respects in 2 time periods corresponding to changes in surgeons doing the HTs.
The number of heart transplantations (HTs) at Baylor University Medical Center (BUMC) at Dallas from 1997 through 2012 averaged 18 for each of the 16 years; the number of HTs from 2013 through 2015 averaged 76 for each of the 3 years ( Figure 1 ). This report compares various clinical and morphologic characteristics of the patients undergoing HT in each of the 2 time periods.
Methods
Since March 1993 all cardiac specimens received in the surgical pathology division of the department of pathology of BUMC have been described by WCR and most have been photographed by JMK. All hearts were cleaned of extraneous tissues, fixed in 10% formaldehyde for 2 to 4 days, determined if the specimen floated in a container of formaldehyde, opened, and then weighed after gently patting each surface to remove extraneous fluid (water or formaldehyde). The scales used were accurate to 1.0 g.
The clinical records were then obtained in all 519 patients via the Baylor Health Care System’s electronic medical record (Allscripts Sunrise Enterprise, Chicago, IL). All 519 patients included in this study had a single HT. Patients having > 1 HT were excluded.
Statistical analyses were conducted using STATA 14.1 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). Baseline characteristics were presented as means/medians for continuous variables and proportions for categorical variables. Comparisons were done using chi-square/fisher exact test for proportions and wilcoxon rank-sum/student t-test for continuous variables where applicable. A p value of < 0.05 was deemed to be statistically significant.
The study was approved by the institutional review board.
Results
The major findings are summarized in Table 1 . Several significant differences were found among the patients in the 2 time periods: in the recent time period (2013–2015) compared to the first time period (1997–2012), the men were older (57 years -vs- 55 years); diabetes mellitus was more frequent (37% -vs- 21%); systemic hypertension (by history) was more frequent (59% -vs- 32%); mean body mass index (BMI) was higher (29.2 kg/m 2 -vs- 26.5 kg/m 2 ), and mean heart weight was lower in both men (509 g -vs- 549 g) and women (422 g -vs- 454 g) ( Figure 2 ). There were insignificant differences in gender, frequency of massive cardiac adiposity (floating heart ), reason for HT, frequency of coronary heart disease, and frequency of previous insertion of a left ventricular assist device.
| Variable | TOTAL (N=519) | Transplant (n=519) 1997-2012 (n=291[56%]) | 2013-2015 (n=228[44%]) | P Value |
|---|---|---|---|---|
| Age (years) (Mean ±SD) | 55±11 | 55±11 | 56±11 | |
| Range [median] | 19-76 [57] | 19-73 [57] | 20-76 [58] | 0.06 |
| Men | ||||
| Mean ±SD | 56±11 | 55±11 | 57±11 | |
| Range [median] | 19-76 [59] | 19-73 [58] | 20-76 [60] | 0.04 |
| Women | ||||
| Mean ±SD | 53±11 | 53±11 | 53±11 | |
| Range [median] | 26-69 [55] | 26-69 [55] | 26-69 [55] | 0.69 |
| Sex | ||||
| Men | 385 (74%) | 219 (75%) | 166 (73%) | |
| Women | 134 (26%) | 72 (25%) | 62 (27%) | 0.53 |
| Diabetes Mellitus | 147 (28%) | 62 (21%) | 85 (37%) | <0.001 |
| Hypertension (by history) | 227 (44%) | 92 (32%) | 135 (59%) | <0.001 |
| Body Mass Index (kg/m2) (Mean ±SD) | 27.7±5 | 26.5±4 | 29.2±5 | <0.001 |
| Range [median] | 16.9-42.3 [27.5] | 16.9-38 [26.9] | 17.8-42.3 [28.9] | |
| Men | ||||
| Mean ±SD | 27.9±5 | 26.9±4.2 | 29.1±5 | <0.001 |
| Range [median] | 16.9-41.4 [27.8] | 16.9-38 [27.2] | 19-41.4 [28.8] | |
| Women | ||||
| Mean ±SD | 27.0±5 | 25.1±4 | 29.1±6 | <0.001 |
| Range [median] | 17.4-42.3 [26.5] | 17.4-33.8 [25.3] | 17.8-42.3 [29.0] | |
| Floating Heart | 202 (39%) | 113 (39%) | 89 (39%) | 0.96 |
| Heart Weight (g) (Mean ±SD) | 508±119 | 526±117 | 485±118 | |
| Range [median] | 215-940 [495] | 232-940 [513] | 215-883 [480] | 0.0001 |
| Men | ||||
| Mean ±SD | 532±115 | 549±110 | 509±118 | |
| Range [median] | 215-940 [515] | 312-940 [540] | 215-883 [501] | 0.0008 |
| >400g | 345 (90%) | 207 (95%) | 137 (83%) | <0.001 |
| Women | ||||
| Mean ±SD | 439±100 | 454±106 | 422±91 | |
| Range [median] | 232-755 [428] | 232-726 [441] | 235-755 [423] | 0.08 |
| >350g | 112 (84%) | 63 (88%) | 49 (79%) | 0.19 |
| Diagnosis | ||||
| Ischemic Cardiomyopathy | 228 (44%) | 137 (47%) | 91 (40%) | 0.10 |
| Idiopathic Dilated Cardiomyopathy | 190 (37%) | 99 (34%) | 91 (40%) | 0.17 |
| Others | 101 (19%) | 55 (19%) | 46 (20%) | 0.72 |
| Coronary Artery Disease | 233 (45%) | 136 (47%) | 97 (43%) | 0.34 |
| Healed myocardial infarct | 191 (37%) | 115 (40%) | 76 (33%) | 0.15 |
| Acute myocardial infarct | 3 (0.6%) | 2 (0.7%) | 1 (0.4%) | NA |
| Both | 3 (0.6%) | 1 (0.3%) | 2 (0.9%) | 0.59 |
| Neither | 47 (9%) | 28 (10%) | 19 (8%) | 0.65 |
| Left Ventricular Assist Device | 96 (18%) | 50 (17%) | 46 (20%) | 0.38 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
