Impact of pulmonary hypertension on early hemodynamics, morbidity and mortality after orthotopic heart transplantation. A single center study

Helena Bedanova,Marek Orban,Petr Hude,Dusan Vrsansky,Jiri Ondrasek,Petr Nemec,Jan Krejci,Lenka Spinarova

doi:10.5507/bp.2012.026

Abstract

To determine the effect of pre-existing pulmonary hypertension (PHT) on early hemodynamics, morbidity and mortality after heart transplantation (HTx). Data were prospectively collected from 149 patients, who underwent HTx between January 2000 and December 2007. The subjects were divided into 3 groups: Group A (n=84) without PTH, group B (n=50) with mild to moderate PTH and group C (n=15) with severe PTH. We studied hemodynamic profile, tricuspid valve regurgitation (TR), incidence of acute cellular rejections (AR), infections, duration of hospitalization, 30-day mortality and a long-term survival. Baseline characteristics were similar in all groups. Using vasodilator treatment PVR was successfully brought down to normal range 2.5 ± 0.6 Wood' units (WU) on the day 1 following the surgery in all groups. Over 80% of patients were treated in Group C, 32% in Group A and 46% in Group B. There was no significant difference in the severity of TR among the 3 groups early after HTx (severe TR was observed in 46%, 54%, 33%, respectively). There was no significant difference in incidence of AR (G ≥ 2 Banff classification) (23%, 23%, 33%, respectively), infections (28%, 32%, 33%, respectively) or duration of hospitalization (30, 30, 28 days, respectively). There was no correlation between pre-transplant PHT and 30-day mortality or a long-term survival. In our cohort, PHT dropped very quickly after HTx, and was not associated with acute right heart failure following the surgery. Reversible PTH does not have a negative impact on short- or long-term survival after HTx.

Highlights

The prognostic impact of pulmonary hypertension before and after heart transplantation is debated
The main findings in the present study are the following. (I) pre-transplant PTH when reversible, does not influence short-or long-term survival after HTx; (II) hemodynamic variables improve to nearnormal values within the first several days in most HTx recipients and (III) pre-transplant PH is not associated with increased risk of acute graft rejections or infections
When the precapillary hypertension component is associated with left heart failure, the elevation of pulmonary pressure is out of proportion to left atrial pressure: a transpulmonary gradient greater than 12 mmHg and pulmonary vascular resistance greater than three WU

Summary

Introduction

The prognostic impact of pulmonary hypertension before and after heart transplantation is debated. In the 1971s Griepp at al.[1] first reported the relationship between elevated preoperative pulmonary vascular resistance and risk of death from acute right ventricular (RV) failure after heart transplantation. Other studies confirmed this association[2,3,4]. Subsequent analyses of larger number of patients confirmed PVR as an incremental risk factor for early death after transplantation. Preoperative pulmonary hypertension and increased PVR have been associated with post-transplant morbidity from acute RV failure and higher perioperative mortality, but they have has been associated with other causes of postoperative morbidity, including post-transplant infections and arrhythmias[5]. Irreversible pulmonary hypertension is one of the main factors that contraindicate heart transplantation

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Results

Conclusion