Comparison of Characteristics of Patients Undergoing Heart Transplantation at the Same Hospital in Two Different Time Periods (1997-2012 and 2013-2015)




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.




Figure 1


Bar graph showing numbers of heart transplants performed at Baylor University Medical Center Dallas from 1997 through 2015 subdivided by age groups in years.


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.



Table 1

Comparison of certain variables among patients having cardiac transplantation at Baylor University Medical Center in 2 time periods: 1997-2012 -vs- 2013-2015


































































































































































































































































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

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Nov 25, 2016 | Posted by in CARDIOLOGY | Comments Off on Comparison of Characteristics of Patients Undergoing Heart Transplantation at the Same Hospital in Two Different Time Periods (1997-2012 and 2013-2015)

Full access? Get Clinical Tree

Get Clinical Tree app for offline access