H. C. Cockrell1, J. Davidson2, K. T. Carter1, R. O’Brien3, T. B. Shaw1, D. A. Baran4, M. E. Kutcher1, J. Copeland5, H. Copeland6 1University of Mississippi Medical Center,Department Of Surgery,Jackson, MISSISSIPPI, USA 2Univeristy of Mississippi,School Of Medicine,Jackson, MI, USA 3University of Mississippi Medical Center,Department Of Data Sciences,Jackson, MS, USA 4Sentara Heart Hospital,Department Of Cardiology,Norfolk, VA, USA 5University of Arizona,Department Of Cardiothoracic Surgery,Tuscon, AZ, USA 6University of Mississippi Medical Center,Department Of Cardiac Surgery,Jackson, MS, USA
Introduction: In 1974, Dr. Christiaan Barnard performed the first heterotopic heart transplantation. During the early years of cardiac transplant, heterotopic or ‘piggyback’ transplantation was favored over orthotopic transplantation because, in the event of graft failure or severe rejection, the patient’s native heart remained in situ. This technique is now used as a way to expand the donor pool by allowing successful transplantation of donor hearts that would otherwise be unusable due to size discrepancy or prolonged ischemic time. This study evaluates recipient and allograft survival after heterotopic heart transplantation compared to orthotopic transplantation.
Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/1999-03/2018. After exclusions for multi-organ transplant, 41,270 patients went on to receive heart transplants. Of these transplants, 27,410 were orthotopic bicaval, 12,643 were orthotopic traditional (biatrial) 1,180 were total orthoptic total (bicaval and pulmonary venous), and 37 were heterotopic (Figure 1A). Primary outcomes were recipient and allograft survival at 30 days, 1 year, and 17 years post-transplantation. Statistical modeling was performed using random survival forests.
Results: The mean age of donors was 27 years (y) (range < 1 to 53y) and the average age of recipients was 47y (range < 1 to 71y) for heterotopic heart transplants. By comparison, the mean age of donors was 29y (range < 1 to 73y) and 46y (range < 1 to 79y) for all other heart transplant techniques. For heterotopic procedures, 30% of both donors and recipients were female, whereas 31% of donors and 28% of recipients were female for all other procedures. Heterotopic heart transplant recipient survival was shorter than bicaval orthotopic transplants by 330 days (d), traditional ortotopic transplants by 286d, and total ortotopic transplants by 182d (Figure 1B). When looking at allograft survival, heterotopic heart transplants lasted 315d less than bicaval orthotopic transplants, 278d less than traditional orthotopic transplants, and 180d less than total orthotopic transplants based on survival forests (Figure 1C).
Conclusion: Heterotopic heart transplantation, while rarely performed, may be viable option in a select cohort of patients.
