Comparable Outcome and Survival in On- and Off-Hours Heart Transplantation

Background: Outcomes after heart transplantation (HTx) may depend on the time of cardiac surgery, especially if comparing routine-hour and off-hour shifts. This study sought to examine temporal trends in survival and outcome differences between on-hours and off-hours HTX.

Methods: We included patients undergoing HTx in our center between 09/2010 and 08/2023 (n = 296). Off-hours were defined as before 8.00 am or after 6.00 pm, and recipients were divided in two groups whether their surgery fell > 50% in off-hours (n = 163) or not (n = 133).

Results: Baseline characteristics in recipients and donors, with only exception of higher frequency of high-urgency waiting list status in the on-hours group (53% vs. 38%, p = 0.03), were comparable between the groups, including the day of surgery being on a weekend or state holiday. Regarding outcome parameters, both groups did not differ, including duration of mechanical ventilation and need for mechanical life support post-HTx. Concerning survival, neither Kaplan–Meier analysis in survival up to 5-years after transplantation (Log Rank p = 0.276) nor group comparisons showed significant differences between the groups.

	All (n = 296)	On-hours (n = 133)	Off-hours (n = 163)	p
High-urgency waiting list (%)	44.5	53.2	38.3	.027
Predicted heart mass ratio (%)	1 (0.9–1.1)	1 (0.9–1.1)	1 (0.9–1.1)	.20
Cardiac reoperation (%)	62.3	62.4	62.4	>0.99
Total graft ischemia time (min)	213 (187–237)	214 (188–239)	213 (187–238)	.49
Surgery on Weekend or Holiday (%)	30.4	34.9	25.6	.122
Duration of surgery (%)	413 (338–502)	420 (340–505)	395 (337–502)	.28
Mechanical ventilation (h)	65 (25–175)	76 (20–187)	60 (28–164)	.45
ECLS post HTx (%)	28.5	32.7	26.0	.31
1-year survival n (%)	168/210 (80.0)	73/93 (78.5)	94/116 (81.0)	.73

Conclusion: Off-hours surgery in heart transplantation was not associated with decrease in survival or worsened outcome. However, limited through the study’s single-center retrospective character, the current management of surgical timing seems to be safe and reasonable.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024