Abstract 13661: Low Organ Perfusion Pressure Indexed To Body Surface Area Predicts Poor Sur vival Even After Heart Transplantation If The Right Atrial Pressure Is High

Abstract

Introduction: Increased Right Atrial pressure (RAP) is associated with impaired renal function and mortality in patients with heart failure. Reduced renal perfusion pressure is associated with deranged renal function. Hypothesis: The effect of high RAP on survival may persist even after heart transplantation if the organ perfusion pressure indexed to body surface area (OPPI) is low. OPPI is more sensitive than organ perfusion pressure (OPP) in predicting survival. Methods: 277 patients who had a heart transplant between October 2012 to march 2020 were included in the study . OPP was calculated as : Mean arterial pressure (MAP) - RAP . OPPI was calculated as : (MAP-RAP) / body surface area . Results: There was a more significant negative correlation between OPPI and creatinine (r = -0.4015,p =0.000) than OPP and creatinine (r = -0.0335,p = 0.6187) (fig 1a) . The effect of OPPI on MELD score was also more significant than OPP.( r = -0.2973, p = 0.000 vs r = -0.0335, p = 0.6187). The 90 day mortality after transplantation was more with higher RAP (23.5 % vs 11.5 %, p ~ 0.012 RAP > & < 15) , but not if OPPI was > 40.(10.8 % vs 9.4 %,p ~ 0.817). The 90 day survival was worse with lower OPPI but improved with lower venous pressures.(Fig 1b) The effect of RAP on medium term survival was significantly worse for RAP > 15 (p = 0.0143).(Fig 1c). The effect was absent if OPPI was > 40.(Fig 1d). Survival at 5 years was worse if the OPPI was low . This effect was absent if the RA pressure was low.(1 e,f). Medium survival for mean pulmonary artery pressure more than 40 mm hg was worse but not if OPPI > 40.(Fig 1 g,h). Conclusions: Short and medium term survival after transplantation are worse with high RAP if OPPI is low. OPPI ,a hemodynamic parameter easily measurable, is more sensitive in predicting survival than OPP . OPPI < 40 appears to be deleterious. With high RAP, excessive vasodilatation must be avoided