E. Lushaj1, R. Dhingra2, S. Akhter1, T. Kohmoto1, S. Ulschmidt1, S. Osaki1, A. Badami1, L. Lozonschi1 1University Of Wisconsin,Cardiothoracic/Surgery,Madison, WI, USA 2University Of Wisconsin,Cardiovascular/Medicine,Madison, WI, USA
Introduction: Pre heart transplant (HTx) amiodarone use is very common. Concerns, however, still exist about increased complications related to use of amiodarone in the perioperative period.
Methods: Of all consecutive patients who received HTx at our institution between 1/2004 to 12/2014 (n=208), we compared the peri- and post-operative outcomes of 137 (66%) patients who were taking amiodarone (group 1) for at least 30 days before HTx to 71 (34%) patients not taking amiodarone (group 2).
Results:Age at transplant, BMI, gender, ischemic etiology, diabetes, hypertension status and donor ischemic time, were not different between the two groups (all p>0.05). Similar number of patients had implantable defibrillators prior to transplant (p=0.30). 72% of patients in group 1 and 48% in group 2 had a ventricular assist device prior to transplant (p=0.001). 51% of patients in group 1 and 37% in group 2 had COPD pre-HTx (p=0.058). Median operative time, aortic cross clamp time, intensive care unit time, prolonged ventilation and median hospital length of stay did not differ between groups (p>0.05). Higher cardiopulmonary bypass time was observed in group 1 (203 vs. 187 min; p=0.013). Patients in group 1 had more pneumonias (7% vs. 0%; p=0.024) and a tendency to develop post-transplant atrial fibrillation (7% vs. 1.4%; p=0.085). None of the patients was implanted with a permanent pacemaker. Patients in group 2 had a higher rejection rate (21% vs. 9%; p=0.017). Both groups had similar 30-day readmission and mortality rates (p>0.05). 1-year survival was not affected by use of amiodarone (p=0.98).
Conclusion:Our study showed that pre-operative amiodarone exposure did not protect from post-transplant atrial fibrillation and unexpectedly resulted in even a higher rate compared to control group. As previously reported lower rejection rates were found in patients exposed to pre-transplant amiodarone. Amiodarone use did not impact post-transplant short and long-term survival (p>0.05).