Right Heart Recovery Post Lung Transplant With COVID-19-Related Acute Respiratory Distress Syndrome.

Abstract

Background: Right heart remodeling is noted in patients with severe COVID-19-associated acute respiratory distress syndrome (ARDS). There is limited information regarding right heart recovery following lung transplantation in this cohort. Methods: Retrospective review of institutional transplant database from June 2020 to June 2022 was performed at Northwestern University in Chicago, Illinois. Demographic, laboratory, histopathologic, lung transplant outcomes, and pre- and postoperative echocardiographic data were recorded and analyzed. Results: Of the 42 patients who underwent lung transplantation for COVID-19-related ARDS, 6 patients were excluded due to having either a single-lung transplant (n = 2), lobar transplant (n = 1), or dual-organ transplant (n = 1) or for missing postoperative TTE data (n = 2) and 36 were included in the study; there were no 90-day deaths, and the 1-year survival rate was 88.8%. Intraoperative hemodynamics data showed a mean pulmonary artery pressure of 49 ± 23 mm Hg. Preoperative echocardiography was evaluated at a median of 15.5 (10-34.3) (IQR) days preoperatively and 140 (108-201) days (IQR) postoperatively. RV size grade improved from an average of 1.7 ± 0.85 to 1.3 ± 0.6 (p < 0.05), while RV function improved from an average of 2.2 ± 1.2 to 1 ± 1 (p < 0.05). There was a reduction in RVSP from 46.5 ± 18 mmHg to 30.1 ± 7.8 mmHg (p < 0.05) and RV free wall strain showed improvement from -13.9 ± 6.1% to -18.5 ± 5.4% (p < 0.05). Conclusions: The results showed that the RV size and systolic function demonstrate improvement with normalization in a relatively short period following lung transplantation for patients with COVID-19-associated ARDS.