Chaudhary, S.

Abstract Rationale: Early management after heart transplantation is essential for survival and quality of life, but we lack data on how initial clinical measures might predict patient outcomes. This study investigates whether early postoperative hemodynamic and clinical parameters can predict 1-year mortality and complications. Methods: We conducted a retrospective study of 550 heart transplant patients treated at the Mayo Clinic from 2019 to 2023. Demographic, hemodynamic, and clinical data, including Central Venous Pressure (CVP), Pulmonary Arterial Pressure (PAP), cardiac index, Pulmonary Artery Pulsatility Index (PaPi), blood pressure, heart rate, and Vasoactive-Inotropic Score (VIS), were collected. Key outcomes included 1-year mortality, Intensive Care Unit (ICU) and hospital stay durations, and complications such as respiratory issues and Acute Kidney Injury (AKI). Patients were divided into quartiles based on VIS scores to compare clinical outcomes. Logistic regression assessed how each parameter predicted 1-year mortality. Results: The patients’ mean age was 53.3±13.1 years, with 391 (71.1%) male and an average Body Mass Index (BMI) of 27.5±4.9. The median ICU stay was 9 days (Interquartile Range [IQR]: 4-22.8), and the median hospital stay was 35 days (IQR: 17-57.8). Within one year, 28 (5.1%) patients experienced mortality and ICU readmission occurred in 52 (9.5%) patients. Higher VIS quartiles were associated with worse outcomes. Logistic regression revealed three significant predictors of 1-year mortality: higher CVP (p=0.0305) and lower Systolic Blood Pressure (SBP) (p=0.0484) were linked to increased mortality risk, while each unit increase in VIS (p=0.0355) raised mortality odds by 6% (Odds Ratio [OR]: 1.06, 95% Confidence Interval [CI]: 1.004-1.113). Additionally, respiratory complications were seen in 177 (32.2%) patients, and AKI in 407 (74.0%) patients. AKI significantly predicted mortality (OR=2.50, p=0.044), while both ICU readmission (OR=2.98, p<0.001) and AKI (OR=3.49, p<0.001) predicted respiratory complications. Conclusions: Early postoperative hemodynamic and clinical parameters, especially higher VIS scores, are significant indicators of 1-year mortality in heart transplant patients. These findings highlight the importance of early assessment to identify high-risk patients and potentially guide post-transplant management strategies.