Impact of postoperative pulmonary hypertension on outcome after heart transplantation

Lundgren, Jakob; Söderlund, Carl; Rådegran, Göran

doi:10.1080/14017431.2017.1304569

Cited by 10 publications

(10 citation statements)

References 22 publications

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“…to characterize PH severity in among studies (247)(248)(249)(250)(251)(252)(253)(254)(255)(256). There are also diverging findings with regards to the influence of PH after HT, specifically when evaluating pre-operative PH (257).…”

Section: Pre-transplant Considerations In Ph Due To Ahfmentioning

confidence: 99%

ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery

McGlothlin

Granton

Klepetko

et al. 2022

The Journal of Heart and Lung Transplantation

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Section: Pre-transplant Considerations In Ph Due To Ahfmentioning

confidence: 99%

ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery

McGlothlin

Granton

Klepetko

et al. 2022

The Journal of Heart and Lung Transplantation

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“…The results of univariate logistic regression revealed that non-ischemic type cardiomyopathy was a negative risk factor for PVR ≥3 WU compared with ischemic type cardiomyopathy (OR: 0.52, 95% CI: 0.33-0.82, p=0.004). Severe FMR, increased LVESD, and LV diastolic dysfunction grade 3 4).…”

Section: Invasive Hemodynamic Characteristicsmentioning

confidence: 99%

“…The guidelines of the International Society for Heart and Lung Transplantation (ISHLT) recommend serial right heart catheterizations (RHCs) at 3-month intervals in patients with HT, with pulmonary vasodilator testing for patients having PVR ≥3 WU (1). Fixed PH, defined as PVR ≥5 WU despite aggressive treatment with one or more inotropes or pulmonary vasodilators, represents a relative contraindication to HT (1)(2)(3)(4). Association of PVR with mortality assumes a nonlinear form, with mortality increasing steeply for PVR ≥3 WU (5).…”

Section: Introductionmentioning

confidence: 99%

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Bayram

Doğan

Acar

et al. 2021

Anatolian J Cardiol

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Objective: Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6 th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT. Methods: A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm 2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study. Results: The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0-70.2) versus 45.0 (36.0-64.0), p<0.001; 38.0 (30.2-46.6) versus 31.0 (23.0-39.5), p=0.004; 4.0 (2.3-6.8) versus 2.6 (1.2-4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1-3.6, p=0.009; and OR: 3.2, 95% CI: 1.5-6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30-3.82, p=0.003 and OR: 2.30, 95% CI: 1.25-4.26, p=0.008). Conclusion:Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.

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“…Severe pulmonary hypertension in the recipient is one of the major contraindications to heart transplant [1,2] due to high risk of right heart failure. When pulmonary hypertension persists up to 1 year from transplant, clinical outcomes and percentage of long-term survival are really poor [3]. For the above-mentioned reasons, a potential recipient must be evaluated with caution before being added to the waiting list.…”

Section: Recipient With Pulmonary Hypertensionmentioning

confidence: 99%

Anesthesia and Intensive Care Management for Cardiac Transplantation

Baiocchi¹,

Benedetto²,

Agulli³

et al. 2018

Heart Transplantation

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Patient management in heart transplant is quite complex and includes multiple steps from preoperative recipient evaluation to postoperative ICU treatment. Monitoring, anesthesia induction, and cardiopulmonary bypass weaning strategies are discussed. The success of the operation also depends on right heart support especially in case of pulmonary hypertension. Many details like fluid management, well-timed respiratory weaning, and primary graft dysfunction management can make the difference in terms of outcome. Pediatric heart transplants represent a small group of total cardiac transplant, but the differences in anatomy and physiology make the surgical and anesthesiological management more complex in unique scenario that requires a specific knowledge at different stages of growth, from newborn through childhood up to adulthood.

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Impact of postoperative pulmonary hypertension on outcome after heart transplantation

Cited by 10 publications

References 22 publications

ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery

ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Anesthesia and Intensive Care Management for Cardiac Transplantation

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