Reversibility of pulmonary hypertension in patients evaluated for orthotopic heart transplantation: importance in the postoperative morbidity and mortality

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

“…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. Also 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.…”

Pre-existing Pulmonary Hypertension in Patients With End-stage Heart Failure: Impact on Clinical Outcome and Hemodynamic Follow-up After Orthotopic Heart Transplantation

“…[1][2][3][4][5][6][7][8] An International Society for Heart and Lung Transplantation (ISHLT) report showed the correlation of PVR with mortality occurring in a linear fashion. 10 The important role of response to vasodilation prior to transplantation has been described in candidates with PHT. 3,5,7,9,10 There is still conflicting data regarding the degree of PHT associated with an unfavorable prognosis.…”

“…10 The important role of response to vasodilation prior to transplantation has been described in candidates with PHT. 3,5,7,9,10 There is still conflicting data regarding the degree of PHT associated with an unfavorable prognosis. [7][8][9][13][14][15][16][17]22 However, a decrease in PVR immediately and over the time after surgery has been reported in patients with pre-transplant PHT.…”

“…4 Aggressive vasodilator intervention before HT can identify a group with reversible PHT. 3,5,7,9,10 The degree of pre-operative PHT and reversibility in response to pharmacologic vasodilation have been considered to have an important impact on outcomes. The levels of PHT above which post-operative mortality and morbidity are increased have varied among studies.…”

45-year-old man with hypertrophic cardiomyopathy after alcohol ablation, progression to dilated cardiomyopathy (RCD code: III‑1B.8a)

“…However, severe and non-reversible secondary pulmonary hypertension, which is the result of an advanced LV systolic and diastolic dysfunction, is a classic contraindication for HTX [12]. Such a secondary pulmonary hypertension might have probably caused acute right ventricle insufficiency of newly-transplanted heart, which would dramatically increase the incidence of premature mortality in perioperative period [13,14]. The patient, discussed in this case report, had moderate secondary, venous pulmonary hypertension with relatively low pulmonary vascular resistance (<2,9 Wood units).…”