Monday, May 8, 2023: 9:15 AM - 12:00 PM
Los Angeles Convention Center
Posted Room Name: West Hall B
Track
Adult Cardiac
Congenital
Multi-Specialty
Perioperative Care
Thoracic
103rd Annual Meeting
Presentations
Total Time: 5 Minutes
Total Time: 40 Minutes
Guest Lecturer
*Toni Lerut, UZ Gasthuisberg
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Leuven, oost brabant
Belgium
Total Time: 20 Minutes
Objective: Recently, a number of centers in the US have begun performing donation after circulatory death (DCD) heart transplants (HTx) in adults with heart failure. We sought to characterize the recent national trends in HTx DCD donor utilization and outcomes in comparison with donation after brain death (DBD).
Methods: Using the United Network for Organ Sharing (UNOS) database, 11,206 adult (>18yo) HTx recipients from January 2019 to June 2022 were identified, of which 454 (4%) were DCD recipients and 10,752 (96%) were DBD recipients. Comparisons between groups were done using Student's t-test & Pearson's chi-squared test, & logistic regression. Univariable (Kaplan Meier) and multivariable (Cox hazards) regression was used to analyze post-transplant survival in DCD group.
Results: DCD recipients were older (57 vs 56y, P<0.001), more likely to be listed as status 2 (p<0.001), had longer wait times (44.0 vs 32.0 d, p=0.002), and more VAD use (p=0.002). DCD donors were younger (29 vs 32y, p<0.001), had longer ischemic time (4.9 vs 3.4 hrs, p<0.001), less renal dysfunction (p<0.001) in comparison with DBD group. Logistic regression analysis showed DCD recipients are more likely to be male (p=0.010) and heavier (p<0.001) and less likely to require ECMO or inotropes (p=0.034 & p<0.001, respectively). On multivariable regression, only longer waitlist time (30-150) was associated with post-transplant survival in DCD group (HR=2.071 [1.095–6.660]). Post-transplant length of stay was shorter in DCD cohort (16 vs 17, p=0.023). One and two-year survival were similar in both groups (P=0.700).
Conclusions: In this UNOS registry, DCD recipients had shorter length of hospital stay and similar post-transplant survival compared to DBD group. DCD recipients were less ill at transplant with greater VAD use. Long waitlist time is a risk factor for poor outcomes post DCD heart transplantation. Given early success with post-transplant survival, effort should be made to expand the pool of eligible recipients.
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Invited Discussant
*Edward Soltesz, Cleveland Clinic
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Cleveland, OH
United States
Abstract Presenter
Hosam Ahmed, Cincinnati Children's Hospital Medical Center
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Cincinnati, OH
United States
Total Time: 20 Minutes
Objective
We have recently reported the primary results of CALGB/Alliance 140503, a randomized trial in patients (pts) with peripheral cT1aN0 NSCLC (AJCC 7th) treated with either lobar (LR) or sublobar resection (SLR). Here we report differences in DFS, OS and recurrence free survival (RFS) between LR, segmental (SR) and wedge resections (WR). We also report differences between WR and SR in surgical margins, rates of locoregional recurrence (LRR) and expiratory flow rates at 6 months postoperatively.
Methods
Between 6/07 and 3/17, 697 pts were randomized to LR (357) or SLR (340) stratified by clinical tumor size (1cm,1-1.5 cm,>1.5-2.0cm), histology and smoking history. 10 patients were converted from SLR to LR and 5 from LR to SLR. Surgical margins in the SLR group were measured intraoperatively by the surgeon. LRR was defined as recurrent disease in the lung or the hilar nodes of the index lobe. Survival end points were estimated by the Kaplan–Meier estimator, and tested by logrank test. Kruskal-Wallis test was used to compare margins and FEV1 changes between groups; and Chi-square test was used to test the association between recurrence and groups.
Results
362 pts had LR, 131 had SR and 204 had WR. Baseline demographic and clinical characteristics were similar between all three groups. 5-year DFS was 64.7% after LR [95% CI; 59.6-70.1%], 63.8% after SR [ 95% C; 55.6 − 73.2%] and 62.5% after WR [95% CI; 55.8 − 69.9%] (Logrank, p = 0.888). Five year OS was 78.7% after LR, 81.9% after SR and 79.7% after WR (Logrank, p = 0.873). RFS was 72% after LR, 68.5% after SR and 69.8% after WR (Logrank, p = 0.709). There were no differences between groups in the cumulative incidence of lung cancer deaths or competing causes of death. LRR occurred in 10% of pts after LR, 12% after SR and 14% after WR (p=0.295). Information on surgical margins was available for 136 patients after WR (66%) and 76 after SR (58%). Median margin length was 1.6 cm after WR and 2.0 cm after SR (p=0.03). Median margin/clinical tumor ratio was 1.2 after WR and 1.3 after SR (p=0.07) A positive surgical margin was present in 3 patients after LR (0.8%), 2 patients after SR (1.5%) and 10 patients after WR (4.9%) (Fisher's exact, p=0.007). At 6 months postoperatively, the median reduction in % FEV1 was 5% after WR and 3% after SR (p=0.9304)
Conclusions
In this large randomized trial, LR, SR and WR were associated with similar survival outcomes. Although LRR was numerically higher after both modalities of SLR compared to LR, the difference was not clinically meaningful. There was no significant difference in the reduction of FEV1 between the SR and WR groups.
Support: U10CA180821, U10CA180882; https://acknowledgments.alliancefound.org ClinicalTrials.gov Identifier: NCT00499330
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Invited Discussant
*Valerie Rusch, Memorial Sloan Kettering Cancer Center
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New York, NY
United States
Abstract Presenter
*Nasser Altorki, New York Presbyterian
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New York, NY
United States
Total Time: 20 Minutes
Objective: We sought to determine the difference in patient characteristics and overall survival for infants with critical left heart obstruction (CLHO) who received bilateral pulmonary artery banding (bPAB) ± ductal stent palliation versus those who received other management strategies (e.g. Norwood, primary transplant, biventricular repair, or surgical/transcatheter aortic valvotomy).
Methods: From 2005-2019, 214 of 962 (22%) infants enrolled in the Congenital Heart Surgeons' Society CLHO cohort underwent bPAB ± ductal stent palliation at 24 institutions. Median follow-up was 8.6 years (range: 0.01-17.4 years). Using a weighting method based on propensity analysis, infants who had bPAB were matched to infants who received other management strategies on variables significantly associated with mortality and variables noted to be significantly different between the two groups. Applying the propensity weighting method, parametric hazard modeling for overall survival was performed (data from all 962 infants were incorporated and weighted) and bootstrap resampling was used to compare risk-adjusted survival between groups.
Results: Compared to infants who received other management strategies, infants who underwent bPAB had higher prevalence of prenatal interventions, non-cardiac comorbidities (e.g. genetic syndromes), preoperative intubation, absent interatrial communication, moderate or severe mitral valve stenosis, lower birth weight, and younger gestational age (all p-values <0.03). For survivors after bPAB, 10% (21/214) had primary transplant, 9% (19/214) had biventricular repair, and 65% (138/214) had univentricular palliation. For the 748 infants who received other management strategies, 1% (10/748) had primary transplant, 14% (104/748) had biventricular repair, and 84% (625/748) had Norwood operation. After applying propensity weighting to both groups, the 12-year risk-adjusted survival after bPAB versus other management strategies was 58% and 63%, respectively (early hazard phase p=0.36, late hazard phase p=0.96; Figure 1).
Conclusions: Infants born with CLHO who underwent bPAB have more high-risk patient-related and anatomic characteristics versus infants who received other management strategies. However, after risk-adjustment, overall survival was similar between the two groups. Mortality remains high for infants born with CLHO, especially for those who have high-risk characteristics, and a bPAB palliation strategy has not diminished this risk
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Invited Discussant
*Pedro del Nido, Boston Children's Hospital
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Boston, MA
United States
Abstract Presenter
Madison Argo, Congenital Heart Surgeons' Society Center for Research and Quality
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United States
Total Time: 50 Minutes
Speaker
*Yolonda Colson, Massachusetts General Hospital
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Boston, MA
United States