Right ventricular failure after heart transplantation: relationship with preoperative haemodynamic parameters

Abstract

The prevalence of right ventricular failure after ~rthotopic heart transplantation, evaluated in 196 patients, was 11.7%, as assessed by the presence during the first postoperative month of right atrial pressure >.10 mmHg. Two deaths, related to refractory right ventncular failure, were observed within the first month, both in subjects with preoperative pulmonary arteriolar resistances > 5 Wood Units. The haemodynamic profile a(fter heart transplantation showed a significant decrease ~ < 0.01) and an early normalization of pulmonary artenal pressure, pulmonary wedge pressure and pulmonary arteriolar resistances, while right atrial pressure slowly decreased until the third month. In a long-term analysis of s~rv.i~al (death within 1 year) the probability of death was stgntftcantly related to the values of right atrial pressure and cardiac index during the first month after heart translantation. Otherwise, the presence of elevated values of n?ht atrial pressure did not show a significant correlation ~Ith the echocardiographic right ventricular end-diastolic b •ameter nor with the presence of right bundle branch lock. The careful selection of patients referred for the c~rdiac transplantation (mean value of pulmonary artelar resistances in the evaluated subjects was 2.5 ± 1.5 ood Units) improves the probability of avoiding the ap-peara~ce of severe right ventricular failure in the postoperative period in most cases. The best predictor of right ventricular failure remains to be clearly identified. ~eY.words: Right ventricular failure-Pulmonary hyperelnston -Pulmonary vascular resistances -Heart transp antation !he development of secondary pulmonary hypertension ~s .~ frequent finding in patients with advanced cardiac 0~\~r e referred for heart transplantation. The evaluation e degree of pulmonary hypertension and pulmonary --~t ;eti~S~S to:vascular resistances is a critical issue in defining the indication for orthotopic cardiac transplantation. Previous experience in transplantation of patients with high pulmonary resistances has resulted in donor right heart failure generally in the early postoperative period.It is still unclear which among the various preoperative haemodynamic parameters indicative of pulmonary hypertension is a good predictor of the clinical and haemodynamicevolution after cardiac transplantation.The purposes of this study were to verify the prevalence of right ventricular failure after cardiac transplantation, to characterize the potential predictors of right ventricular failure after cardiac transplantation, and to evaluate the short-term (1 and 3 months) and long-term (1 year) mortality after heart transplantation in relation to the haemodynamic parameters before and after the cardiac transplant. Between November 1985 and April 1991, 196 orthotopic cardiac transplants were performed at the IRCCS Policlinico S. Matteo of Pavia, according to the criteria of the clinical programme of heart transplantation. MethodsThe patients ranged from 9 to 67 years of age (mean age 43.2); 176 were males and 20 ...

Frequency, Time Course, and Possible Causes of Right Ventricular Systolic Dysfunction after Cardiac Transplantation: A Single Center Experience

“…Higher 1-year posttrans- 15 Campana et al showed that the prevalence of RV dysfunction after heart transplantation was 11.7%, as defined by a right atrial pressure >10 mm Hg during the first postoperative month. 16 In our study, assessment of RV systolic function by TAPSE showed an extremely high prevalence of RV systolic dysfunction. Our findings were likely not artifactual as the average value for TAPSE was significantly depressed and 40% of patients had values >4 SD below a normal control population.…”

“…Campana et al. showed that the prevalence of RV dysfunction after heart transplantation was 11.7%, as defined by a right atrial pressure >10 mm Hg during the first postoperative month …”

The Importance of Tricuspid Regurgitation and Right Ventricular Overload in ICD/CRT Recipients: Beside the Left, beyond the Left

“…8 Regardless of the underlying mechanisms, elevated pulmonary artery pressure (PAP), pulmonary vascular resistance, and RVD appear to be important clinical markers in patients with CHF: they predict reduced survival and response to therapies, as well as poor outcome after orthotopic heart transplantation. [9][10][11] Patients responding to CHF therapy, including pharmacological, electrical, and mechanical, usually show improvements in PH and RVD (as a consequence of decreased left ventricular diastolic pressures). 8 Subjects developing RVD in the context of left heart disease commonly necessitate high doses of loop diuretics in order to relieve right-sided congestion, possibly because of lower cardiac output and high renal venous pressures with reduced glomerular filtration rate.…”

Successful Right Ventricular Mechanical Support After Combined Heart-Liver Transplantation

“…Right ventricular failure after heart transplantation complicates approximately 12% of cardiac transplants. 4 The etiology is multifactorial, likely a combination of inadequate myocardial protection coupled with an inability to respond to increased pulmonary vascular resistance. 5 Dilation, decreased contractility, and tricuspid regurgitation result in decreased cardiac output.…”