Karki, D.

Abstract Rationale: Mechanical ventilation is frequently required in heart transplant patients to support recovery, but prolonged ventilation may increase the risk of complications and mortality. This study is done to find the impact of pre-transplant ventilation duration on early post-transplant outcomes, including mortality, ICU stay, infection, and respiratory complications. Methods: This retrospective analysis includes 52 heart transplant recipients from Mayo Clinic (2019-2023) who required pre-transplant mechanical ventilation. We analyzed ventilation duration's relationship with ICU and hospital stay, infection rates, respiratory complications, mortality, and baseline demographics. Chi-squared and Mann-Whitney U tests were used to evaluate associations between co-morbidities, ventilation duration, and outcomes. Results: The mean age at transplant was 48.9±14 years. Average ventilation duration was 12.8±14.2 days (Median: 7 days), ICU stay was 24.8± 20.9 days (Median: 15.0 days), and hospital stay was 58±40.8 days (Median: 48 days). Of the patients, 5 (9.6%) did not survive. There was no statistically significant association between mortality and ventilation duration, with a mean duration of 12.7±14.6 days (Median: 7 days) for survivors and 13.6±11.5 days (Median: 21 days) for non-survivors (p>0.05). Patients with infections 23 (44.2%) or respiratory complications 17 (32.7%) had longer ventilation durations (mean 16.3±17.8 days, Median: 9 and 10 days, respectively) compared to those without complications (mean 10±10.2 days, Median: 6 and 5 days, p>0.05). Infection was associated with extended ICU stays (mean 27.5±22.3 days, Median: 18 days with infection vs. 22.7±19.9 days, Median: 15 days without infection). None of the individual co-morbidities (diabetes, hypertension, stroke, chronic kidney disease) significantly impacted mortality or ventilation duration (p > 0.05). Conclusions: Prolonged ventilation is associated with increased rates of infections and respiratory complications but not with mortality in this cohort. Although co-morbidities did not significantly impact ventilation duration or mortality, infection remains a critical factor related to extended ICU stay. Future research should explore preventative strategies for infections in ventilated heart transplant recipients to improve outcomes.