Comparing Short/Long-Term Outcomes of Heart Transplants That Occur Inside and Outside of Normal Working Hours

Purpose Heart transplantation involves many factors, such as donor selection,recipient management,multidisciplinary assessment,coordination with other organ teams, and transportation. Because of these unpredictable factors,heart transplantations can be conducted at any time of day. In some reports,clinical outcomes vary depending on the time of the day a surgery takes place. However, this is not well documented in heart transplantation. The purpose of this study is to investigate if outcomes differ between heart transplants taking place inside or outside of normal working hours. Methods We reviewed patients who underwent heart transplantation from January 2010 to July 2020(n=329). Based on the documented start time of transplant, the cohort was divided into two groups: working-hours (Group A: 7:30AM to 5PM; n=92) and after-hours (Group B:5PM to 7:30AM; n=237). We reviewed early and late clinical outcomes including survival. Long-term survival was compared using the Kaplan-Meier method. Results The patients in Group A(51.2±14.7 years old) were younger than Group B (54.6±12.4, p=0.03). There were no significant differences between the two groups in gender, previous history of cardiac surgery, preoperative creatinine, ejection fraction and support of intra-aortic balloon pump. In-hospital mortality was not significantly different between the two groups (6.5%,4.6%;p=0.50). Ischemic time (237.0±60.2, 231.0±58.9 min; p=0.42) and cross-clamp time (149.4±37.3 min, 146.7±37.1 min; p=0.57) did not differ between the groups. In terms of postoperative complications, there were no significant differences between two groups in stroke (6 patients,7 patients; p=0.16), primary graft dysfunction requiring extracorporeal membrane oxygenation (5 patients, 21 patients; p=0.28), reexploration for bleeding (8 patients, 24 patients; p=0.68) and newly required hemodialysis (8 patients, 15 patients; p=0.46). The survival rate in Group A (87.6% at 1year,80.1% at 3years and 77.6% at 5years) was not significantly different from Group B (90.9% at 1year,84.6% at 3years and 79.9% at 5years, log rank=0.75). Conclusion There was no significant difference in clinical outcomes between heart transplants taking place inside or outside of working hours. A high level of quality of care can be provided to transplant recipients during after hours with a great team effort.