CONGRESS ABSTRACT

INTRODUCTION While Heart transplantation (HTx) remains the gold standard treatment for Advanced heart failure (AHF), the short donor availability prolongs the risk of long awaiting times, favoring the rate of re-hospitalization and development of end-organ damage and pulmonary artery hypertension, conditions worsening post transplantation outcomes.  Intermittent Levosimendan infusions (ILIs) are an appealing strategy to bridge patients to HTx: studies on AHF have shown a reduction of hospitalizations rate and an improvement in laboratory data.  We analyzed the post transplantation outcome of a cohort of patients bridged to HTx with an ILIs strategy. METHODS Among the 272 patients undergoing HTx in our AHF unit from 2011 to 2020, 30 patients were bridged to HTx with an ILIs strategy, defined as the monthly repetitive administration of Levosimendan for at least 3 infusions. The infusion protocol consisted in injecting Levosimendan on a dose ranging from 0.05 mcg/kg/min to 0.1 mcg/kg/min during 24 hours. The dose adjustments were adapted for the single patient, at the physician discretion, and repeated on 30 days intervals. We analyzed the 1-year post transplant mortality and the hemodynamic, echocardiographic and laboratory evolution of the patients while in the awaiting list, comparing data at the beginning of the infusions and before HTx. RESULTS The 1-year post transplantation mortality rate was 13%. Comparing data before the beginning of the ILIs and before HTx, we found a significant reduction in pulmonary artery pressures, in pulmonary vascular resistance and in filling pressures with an improvement in cardiac index, grade of mitral regurgitation and end organ damage. CONCLUSIONS In this cohort of patients bridged to HTx with an ILIs strategy, the 1-year post transplantation mortality rate was in line with the overall European Data on HTx survival. ILIs allowed for a hemodynamic and laboratory improvement of the cohort, contributing in preserving patients during the wait for a suitable donor.