Aims The impact of mechanical ventilation (MV) at the time of heart transplantation is not well understood. In addition, MV was recently removed as a criterion from the new US heart transplantation allocation system. We sought to assess for the association between MV at transplantation and 1-year mortality. Methods and results We utilized the United Network for Organ Sharing database and included all adult, single organ heart transplantations from 1990 to 2019. We utilized multivariable logistic regression adjusting for demographics, comorbidities, and markers of clinical acuity. We identified 60 980 patients who underwent heart transplantation, 2.4% (n = 1431) of which required MV at transplantation. Ventilated patients were more likely to require temporary mechanical support, previous dialysis, and had a shorter median waitlist time (21 vs. 95 days, P < 0.001). At 1 year, the mortality was 33.7% (n = 484) for ventilated patients and 11.7% (n = 6967) for those not ventilated at the time of transplantation (log-rank P < 0.001). After multivariable adjustment, patients requiring MV continued to have a substantially higher 90-day [odds ratio (OR) 3.20, 95% confidence interval (CI): 2.79–3.66, P < 0.001] and 1-year mortality (OR 2.67, 95% CI: 2.36–3.03, P < 0.001). For those that survived to 90 days, the adjusted mortality at 1 year continued to be higher (OR 1.48, 95% CI: 1.16–1.89, P = 0.002). Conclusion We found a strong association between the presence of MV at heart transplantation and 90-day and 1-year mortality. Future studies are needed to identify which patients requiring MV have reasonable outcomes, and which are associated with substantially poorer outcomes.

中文翻译：

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心脏移植时的机械通气及其与临床结果的关联

目的 机械通气 (MV) 在心脏移植时的影响尚不清楚。此外，最近将 MV 作为一项标准从新的美国心脏移植分配系统中删除。我们试图评估移植时 MV 与 1 年死亡率之间的关联。方法和结果 我们利用了器官共享联合网络数据库，包括了 1990 年至 2019 年的所有成人单器官心脏移植。我们利用多变量逻辑回归调整了人口统计学、合并症和临床敏锐度标志物。我们确定了 60980 名接受心脏移植的患者，其中 2.4%（n = 1431）在移植时需要 MV。通气患者更可能需要临时机械支持、既往透析，并且等候名单中位时间更短（21 vs. 95天，P＜0.001)。1 年时，通气患者的死亡率为 33.7%（n = 484），移植时未通气的患者死亡率为 11.7%（n = 6967）（对数秩 P < 0.001）。多变量调整后，需要 MV 的患者在 90 天时继续显着提高 [优势比 (OR) 3.20, 95% 置信区间 (CI): 2.79–3.66, P <; 0.001] 和 1 年死亡率 (OR 2.67, 95% CI: 2.36–3.03, P < 0.001)。对于存活至 90 天的患者，调整后的 1 年死亡率继续较高（OR 1.48，95% CI：1.16-1.89，P = 0.002）。结论 我们发现心脏移植时 MV 的存在与 90 天和 1 年死亡率之间存在密切关联。需要未来的研究来确定哪些需要 MV 的患者有合理的结果，