Severe right heart failure after heart transplantation. A single-center experience

Abstract

Summary We reviewed our heart transplantation recipient population, using hard criteria defining severe right heart failure (RHF), and analyzed possible risk factors for outcome after RHF. Between 1983 and 1998 621 cardiac transplantations were performed at our institution. RHF was defined by the necessity to implant an assist device or echocardiographically confirmed right ventricular ballooning with concomitant end organ failure. RHF patients were compared with a matched control group. Thirty‐five patients (5.9%) with severe RHF after transplantation fulfilled inclusion criteria. Of these, 32 patients died, while none of the control patients died (P < 0.001). Increased preoperative pulmonary capillary wedge (P = 0.005) and mean pulmonary artery pressure (P = 0.006) were identified as significant risk factors for severe RHF. Severe RHF as defined in our study is irreversible in almost every case without differences among therapeutical concepts. Hence, improvement of postoperative outcome necessitates avoidance or aggressive therapy of possible risk factors.

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

“…On multivariate analysis, ischemic time (P = 0.017) and early posttrans- (Table III). 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.…”

“…Using a restrictive set of clinical criteria, Klima et al. reported that 5.9% of transplanted patients developed severe RV dysfunction early posttransplant . Campana et al.…”

Right Ventricular Failure Following Heart Transplantation-Recovery After Extended Mechanical Support

“…Early right‐sided circulatory failure following heart transplantation remains a challenge for physicians and has dismal prognosis 3 . Therapeutic options are limited if right ventricular failure is resistant to conservative treatment.…”

Management of Pulmonary Hypertension and Right Heart Failure in the Intensive Care Unit

“…Right ventricular assist devices (RVAD) in the form of centrifugal pumps can be surgically implanted (CentriMag, Thoratec Corporation, Pleasanton, CA) or percutaneously inserted (TandemHeart, Cardiac Assist, Pittsburg, PA) with or without an oxygenator and divert blood from the vena cava or right atrium to the pulmonary artery or left atrium, effectively bypassing the right ventricle. Right ventricular assist devices have been successfully used in patients with RV failure following right ventricular infarct, postcartiotomy shock, cardiac transplantation, and left ventricular assist device implantation [68][69][70][71].…”