Cardiac Power Output Index and Severe Primary Graft Dysfunction After Heart Transplantation

“…Furthermore, areas under the receiver-operator characteristic curve for CPOi at T0 and T6 for developing severe PGD were 0.90 and 0.92, respectively. 8 Although it can be argued that several measurements have an association with PGD, the authors also showed that the area under the receiver-operator characteristic curve for CPOi was higher than that of other more common hemodynamic parameters, such as cardiac index or vasoactive-inotropic score. They concluded that a CPOi at T0 <0.34 W/m 2 had a sensitivity of 86% and specificity of 87% for the primary endpoint of severe PGD.…”

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confidence: 96%

“…In the current of issue of Journal of Cardiothoracic and Vascular Anesthesia, Lim et al reported the utility of the cardiac power output (CPO) for predicting severe PGD (MCS and/or mortality within 30 days) after heart transplantation. 8 This hemodynamic parameter is a product of the cardiac output (or index) and the mean arterial blood pressure. CPO describes the hydraulic energy generated by the cardiac chambers per unit time, and it is a measurement of cardiac pumping ability.…”

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confidence: 99%

“…CPO describes the hydraulic energy generated by the cardiac chambers per unit time, and it is a measurement of cardiac pumping ability. 8,9 The authors hypothesized that patients with a low CPO in the early period after transplant would have a greater need for MCS (severe PGD). Lim et al analyzed CPO in 160 heart transplant patients over a 6-year period (2014-2019).…”

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confidence: 99%

“…Looking at the opposite end of the outcomes, the likelihood of severe PGD occurring if both CPOi at T0 and T6 were >0.34 W/m 2 and >0.33 W/m 2 , respectively, was only 2%. 8 The significance of the work by Lim et al easily can be overlooked given that patients with severe PGD are expected to have a lower cardiac index and lower blood pressure (therefore, lower CPOi). However, the addition of CPOi as a parameter gives clinicians an opportunity to have earlier identification (with high-predictive value) of patients who are at risk of multiorgan failure.…”

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confidence: 99%

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A New Tool for Timely Rescue of Heart Transplant Patients with Severe Primary Graft Dysfunction

Patel

2021

Journal of Cardiothoracic and Vascular Anesthesia

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ADVANCEMENTS IN heart transplantation have come a long way since Barnard, Shumway, and other pioneers first performed the revolutionary procedure more than 50 years ago. 1 Progress in appropriate donor and recipient selection, organ protection, surgical and anesthetic techniques, and postoperative management have significantly reduced the initial mortality rates once seen with heart transplant. Indeed, the early years of 1968-to-1970 saw worldwide 1-year survival at 18% and 2-year survival at only 11%. 2 Today, 1-year survival of heart transplant patients is as high as 85%. 3 Despite the significant improvement in long-term survival, current-day heart transplant recipients remain at high risk for postoperative morbidity and mortality due to primary graft dysfunction (PGD). PGD occurs within the first 24 hours after transplant, and it results in single or biventricular dysfunction with low cardiac output and hypotension despite adequate filling pressures. 4 Unlike secondary graft dysfunction, there remains no identifiable cause. Although consensus statements exist on characterizing PGD, there remains variability on PGD diagnosis and definition from one center to another. This has ultimately contributed to a wide range in the reported incidence of PGD, from 2.3% to 28.2%. 5 Given that PGD is the leading cause of early mortality (fewer than 30-days) after heart transplantation, continued focus remains on predicting and preventing this devastating complication. Registry data demonstrates that 39% of deaths at 30 days are attributed to PGD, and this number has not significantly improved in recent years despite the advancements mentioned above. 6 Risk models for predicting PGD have been validated, and risk factors associated with this multifactorial disease have been identified. 7 Not surprisingly, risk factors are related to donor, procedural, and recipient characteristics. Also, not surprising is that many of these risk factors cannot be eliminated given the limited donor organ pool and the increasing number of end-stage heart failure patients. Therefore, more "marginal" donors are being accepted for older, higher-risk recipients. 7 Furthermore, identifying risk factors (not modifiable

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Derivation of Stroke Volume from Pulmonary Artery Pressures

Yim,

Drury,

Lim

2024

Cardiol Ther

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Introduction Intermittent cardiac output (CO) studies using thermodilution are considered the gold standard. We have developed a stroke volume (SV) calculator from pulmonary pulse pressure (PP) to allow continuous monitoring of SV and CO from PP. Methods Hemodynamic data on 169 patients following orthotopic heart transplantation were used to compare our calculator-derived SV (and SV index, or SVi) against thermodilution-derived SV on admission into intensive care unit immediately following heart transplantation (T0) and 6 h after admission (T6). Results The calculated SV correlated with thermodilution-derived SV T0 ( r = 0.920, p < 0.001, coefficient of 0.539 and the constant of 2.06). The median calculator SV, adjusted for coefficient and constant, was 48.4 ml (37.7, 60.7), comparable to the median thermodilution-derived SV 47.9 ml (37.5, 61.0), p = 0.737 with acceptable agreement on Bland–Altman plots. The thermodilution-derived SVi was 28.1 ml (19.7, 38.7) and adjusted calculator-derived SVi 28.9 ml (19.7, 39.9), p = 0.781. At T6, median thermodilution-derived SVi was 27.7 ml (19.5, 35.9) compared to the calculator-derived SVi median of 26.1 ml (17.7, 37.7), p = 0.203. Conclusions Changes in PP can be used to track changes in SV using this calculator. Changes in PP may be used to assess response to treatment in the early post-operative period. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-024-00360-x.

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Cardiac Power Output Index and Severe Primary Graft Dysfunction After Heart Transplantation

Cited by 9 publications

References 15 publications

Highlights from the 34th Annual Meeting of the European Association for Cardio‐Thoracic Surgery

Highlights from the 34th Annual Meeting of the European Association for Cardio‐Thoracic Surgery

A New Tool for Timely Rescue of Heart Transplant Patients with Severe Primary Graft Dysfunction

Derivation of Stroke Volume from Pulmonary Artery Pressures

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