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24. Jahrestagung der Deutschen Transplantationsgesellschaft

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10:00 - 11:15
Wissenschaftliche Sitzung: Thorakale Organe II

Vorsitz: Hermann Reichenspurner, Hamburg; Uwe Schulz, Bad Oeynhausen

10:00
V070

Aktueller Stand des Cardiac Allocation Score (CAS): die Hoffnung im Dilemma der Herztransplantation

*Uwe Schulz1
1 Herz- und Diabeteszentrum NRW der Ruhr-Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Deutschland
Abstract-Text :

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10:18
V071

Lung Allocation Score (LAS): Update der bisherigen Erfahrungen und Bedeutung des LAS plus

*Jens Gottlieb1
1 Medizinische Hochschule Hannover, Klinikum für Pneumologie, Hannover, Deutschland
Abstract-Text :

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10:36
V072

Erfahrungen mit OCS-Systemen in der Herz-  und Lungentransplantation und Konditionierung marginaler Organe

*Aron Popov1
1 Royal Brompton & Harefield NHS Foundation Trust, Director of heart and lung transplantation and ventricular assist devices, London, Großbritannien
Abstract-Text :

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10:54
V073

Gender differences in patients undergoing mechanical circulatory support – results using the EUROMACS registry

*Alexander Bernhardt1, Björn Sill1, Theo DeBy2, Jan Gummert3, Paul Mohacsi4, Florian Wagner1, Hermann Reichenspurner1, Tobias Deuse1
1 Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Deutschland
2 EUROMACS registry, , Berlin, Deutschland
3 Herz- und Diabeteszentrum, , Bad Oeyhnhausen, Deutschland
4 Inselspital, , Bern, Schweiz
Abstract-Text :

Background: Mechanical circulatory support (MCS) is an established treatment option for patients with end-stage heart failure. Although there are numerous reports identifying sex-specific differences with respect to progression and prognosis of heart failure, little is known about gender differences in indication and outcome for patients with ventricular assist devices (VAD). Therefore, data from the EUROMACS registry were analyzed.


 


Methods: Between January 2011 and June 2014, a total of 1006 consecutive VAD patients were submitted to the EUROMACS registry. Demographic data, underlying cardiac diseases, and outcomes were analyzed for gender differences.


 


Results: In this European cohort, 168 (16.7%) patients were female and 838 (83.3%) patients were male (p<0.001). ICM was less frequent in female patients (41, 24.4%) than in male patients (372, 44.4%; p<0.001). At the time of VAD implantation, female patients were younger than male patients (48±17yrs vs. 52±12yrs, p<0.001). Women presented in a more critical INTERMACS level compared to men (87 (51.7%) in level 1 or 2 vs. 348 (41.5%); p<0.001). ECMO bridging was more often used in women (21, 12.5%) than in men (78, 9.3%; p<0.001). Temporary or permanent RV support was necessary in 43 (25.6%) women and thus significantly more frequently required than in men (120, 14.3%; p<0.001). Overall, female patients showed significantly inferior 1-year survival (63.7% vs. 75.3%) as well as 2-year (59.7% vs. 66.4%) and 3-year survival (51.1% vs. 60%).


 


Conclusion: Women, who already have an inferior life expectancy when diagnosed with end-stage heart failure, are likely to be transferred in a later and more critical clinical state for VAD implantation. They show a higher incidence of perioperative RV failure and worse long-term survival. We urge that referral strategies and implant timing be revised for female patients to improve their MCS outcome.


 



11:04
V074

Clinical results in heart transplant recipients, receiving donor organs with coronary heart disease compared to donor organs without coronary impairment

*Uwe Fuchs1, Cenk Özpeker1, Buntaro Fujita1, Armin Zittermann1, Stephan Ensminger1, Stefan Wlost1, Uwe Schulz1, Jan Gummert1
1 HDZ NRW Bad Oeynhausen, Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Deutschland
Abstract-Text :

Introduction: Proof of coronary artery heart disease in donor hearts has been considered as contraindication in the majority of the heart transplant centers. Therefore, the aim of the study was to analyze outcome in heart transplant recipients, who received donor organs with positive proof of coronary heart disease (CHD) compared to recipients without coronary heart disease (NCHD) of the donor organs as controlled by coronary angiography. Method:  Between 2006 and 2008 a total number of 91 of the implanted donor hearts received a coronary angiography before heart transplantation. A total number of 16 patients received donor organs (coronary 1 vessel disease; grade of stenosis < 50%) with coronary heart disease (CHD-group). In 75 patients coronary heart disease could be excluded by coronary angiography (NCHD-group).  The coronary heart disease was diagnosed accidently as donors mostly had no medical or conventional treatment of the CHD.  The overall survival and the incidence of initial graft failure were evaluated in both groups.  Results: The baseline characteristics such as age, diagnosis leading to heart transplantation, blood group, MHC I – status, MHC II – status, and the incidence of diabetes mellitus were comparable between the groups and showed no significant difference (p>0.05). The gender differed significantly between the groups (female gender: 25.7 % in the NCHD-group vs. 0 % in the CHD-group; p=0.03).  Furthermore height (p=0.009) and weight (p=0.019) were significantly higher in the CHD group. Multivariate analysis revealed statistically no difference between the two groups.  Overall survival and the incidence of graft failure did not differ significantly between the groups (p>0.05). Conclusion: Reflecting our results the presence of mild CHD in the donor heart seems not to reduce the prognosis such as survival and graft failure, compared to donor hearts without positive proof of CHD diagnosed via coronary angiography in heart transplant recipients.