Right Ventricular Undersizing is Associated With Increased 1-Year Mortality

ABSTRACT Objectives Right heart hemodynamic management is critical as many post-heart transplant (HTx) complications are related to right ventricular failure. However, current guidelines on size and sex matching primarily relies on weight matching, with recent literature utilizing total ventricular mass (TVM), which places less emphasis on the impact of right ventricular mass (RVM) matching. The aim of this study is to analyze the relationship of RVM matching and survival after heart transplantation. Methods We performed a retrospective analysis using the UNOS Database of adult heart transplant from January 1997 to December 2017. Previously validated equations were used to calculate TVM and RVM. Ventricular mass percent difference between the donor and recipient pair was used for the size mismatch. All donor-recipient pairs were divided into 4 RVM groups by their mismatch ratio. We analyzed RVM matching and explored how RVM undersizing impacted outcomes. Primary outcomes measure was 1-year survival; secondary outcomes measured included stroke and dialysis within one year and functional status. Results There were 38,740 donor-recipient pairs included in our study. The 4 RVM match groupings were as follows: 40%. Utilization of donors who were older and of female sex resulted in greater RVM undersizing. Survival analysis demonstrated patients with RVM undersizing had worse 1-year survival (p Conclusion RVM undersizing was an independent predictor for worse 1-year survival. Donors who are older and of female sex have lower absolute predicted RVM and may predispose to RVM undersizing. RVM undersized transplantation requires careful risk/ benefit considerations.