Reverse Right Ventricular Remodeling After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Under Combination Therapy of Targeted Medical Drugs

Sarashina, Toshihiro; Nakamura, Kazufumi; Akagi, Satoshi; Oto, Takahiro; Oe, Hiroki; Ejiri, Kentaro; Nakagawa, Koji; Nishii, Nobuhiro; Matsubara, Hiromi; Kobayashi, Minoru; Morimatsu, Hiroshi; Miyoshi, Shinichiro; Ito, Hiroshi

doi:10.1253/circj.cj-16-0838

Cited by 21 publications

(16 citation statements)

References 27 publications

(10 reference statements)

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“…This single‐centre retrospective data analysis investigates the outcome and distinct right heart functional status in lung transplant patients with the pre‐operative diagnosis of pulmonary hypertension. Our data show that lung transplantation in PH patients yields relatively good survival rates and, importantly, marked regression of both tricuspid valvular dysfunction and right heart failure, which is in line with previous publications …”

Section: Discussionsupporting

confidence: 93%

Lung transplantation in patients with severe pulmonary hypertension—Focus on right ventricular remodelling

Schuba

Michel

Guenther

et al. 2019

Clinical Transplantation

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Objective This study was meant to analyse the centre experience of the Munich Lung Transplant Group in lung transplantation of patients with severe pulmonary hypertension. Outcome data focus on survival and right heart remodelling. Methods All patients receiving a lung transplant between 10/2010 and 08/2016 were retrospectively analysed (n = 343). Patients were categorised into individuals with or without severe pre‐operative pulmonary hypertension (PH; mPAP ≥ 35 mm Hg or mPAP ≥ 25 mm Hg with cardiac index < 2.0 L/min/m2). Among those, patients with severe PH secondary to lung disease (Nice Class III) were compared with patients with severe PH due to idiopathic PH (IPAH; Nice Class I). All surviving patients with severe PH were electively followed up by echocardiography. Results Kaplan–Meier survival probabilities after lung transplantation of each group according to pre‐operative mPAP values showed no statistically significant difference (P = 0.14 by log‐rank test). Lung transplantation in severe PH patients led to marked right ventricular remodelling as indicated by significantly increased tricuspid annular plane systolic excursion (TAPSE) (P = 0.002), decreased right ventricular end‐diastolic dimensions (P = 0.001) and overall reduction in tricuspid valvular regurgitation, when compared to pre‐operative assessments. Conclusion Sequential bilateral lung transplantation (BLTx) in patients with severe pulmonary hypertension is a feasible treatment option in this high‐risk group in experienced high‐volume centres. Lung transplantation allows for resolution of secondary right heart failure in these patients.

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Section: Discussionsupporting

confidence: 93%

Lung transplantation in patients with severe pulmonary hypertension—Focus on right ventricular remodelling

Schuba

Michel

Guenther

et al. 2019

Clinical Transplantation

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“…Indeed, there has been concern that this abnormal diastolic function may persist in the postoperative period and contribute to pulmonary edema. Moreover, post‐LTx LV recovery has been suggested to be delayed or even absent in recent studies .…”

Section: Introductionmentioning

confidence: 99%

Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension

Avriel

Klement

Perrot

et al. 2017

American Journal of Transplantation

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Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.

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“…There is now consensus among experts that bilateral lung transplantation is the procedure of choice for most patients with PAH. Of note, almost any right ventricle recovers within a few weeks after transplantation, regardless of the degree of pre-transplant dilatation and dysfunction, and regardless of the severity of pre-operative tricuspid regurgitation [69–71].…”

Section: Lung Transplantationmentioning

confidence: 99%

Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension

et al. 2019

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Intensive care of patients with pulmonary hypertension (PH) and right-sided heart failure includes treatment of factors causing or contributing to heart failure, careful fluid management, and strategies to reduce ventricular afterload and improve cardiac function. Extracorporeal membrane oxygenation (ECMO) should be considered in distinct situations, especially in candidates for lung transplantation (bridge to transplant) or, occasionally, in patients with a reversible cause of right-sided heart failure (bridge to recovery). ECMO should not be used in patients with end-stage disease without a realistic chance for recovery or for transplantation. For patients with refractory disease, lung transplantation remains an important treatment option. Patients should be referred to a transplant centre when they remain in an intermediate- or high-risk category despite receiving optimised pulmonary arterial hypertension therapy. Meticulous peri-operative management including the intra-operative and post-operative use of ECMO effectively prevents graft failure. In experienced centres, the 1-year survival rates after lung transplantation for PH now exceed 90%.

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Reverse Right Ventricular Remodeling After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Under Combination Therapy of Targeted Medical Drugs

Cited by 21 publications

References 27 publications

Lung transplantation in patients with severe pulmonary hypertension—Focus on right ventricular remodelling

Lung transplantation in patients with severe pulmonary hypertension—Focus on right ventricular remodelling

Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension

Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension

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