Evaluation of a Heart Transplant Candidate

Lee, Sook Jin; Kim, Kyung Hee; Hong, Suk Keun; Hankins, Shelley

doi:10.1007/s11886-017-0934-y

Cited by 20 publications

(18 citation statements)

References 59 publications

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“…Cappola et al ( 5) have determined that PAPm, mean systemic pressure, and PVR were the strongest predictors of mortality in patients with HT, and mortality rates nearly doubled with PVR ≥3 WU. Indeed, irreversible PH (PVR ≥5 despite vasodilators) was accepted as a contraindication for HT (2). In our study, rates of PVR ≥3 WU and PVR ≥5 WU were higher in patients with severe FMR.…”

Section: Discussionsupporting

confidence: 43%

“…The guidelines of the International Society for Heart and Lung Transplantation (ISHLT) recommend serial right heart catheterizations (RHCs) at 3-month intervals in patients with HT, with pulmonary vasodilator testing for patients having PVR ≥3 WU (1). Fixed PH, defined as PVR ≥5 WU despite aggressive treatment with one or more inotropes or pulmonary vasodilators, represents a relative contraindication to HT (1)(2)(3)(4). Association of PVR with mortality assumes a nonlinear form, with mortality increasing steeply for PVR ≥3 WU (5).…”

Section: Introductionmentioning

confidence: 99%

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How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Bayram

Doğan

Acar

et al. 2021

Anatolian J Cardiol

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Objective: Increased pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) are important prognostic factors in patients with heart transplantation (HT). It is well known that severe mitral regurgitation increases pulmonary pressures. However, the European Society of Cardiology and the 6 th World Symposium of pulmonary hypertension (PH) task force redefined severe functional mitral regurgitation (FMR) and PH, respectively. We aimed to investigate the effect of severe FMR on PAP and PVR based on these major redefinitions in patients with HT. Methods: A total of 212 patients with HT were divided into 2 groups: those with severe FMR (n=70) and without severe FMR (n=142). Severe FMR was defined as effective orifice regurgitation area ≥20 mm 2 and regurgitation volume ≥30 mL where the mitral valve was morphologically normal. A mean PAP of >20 mm Hg was accepted as PH. Patients with left ventricular ejection fraction ≤25% were included in the study. Results: The systolic PAP, mean PAP, and PVR were higher in patients with severe FMR than in those without severe FMR [58.5 (48.0-70.2) versus 45.0 (36.0-64.0), p<0.001; 38.0 (30.2-46.6) versus 31.0 (23.0-39.5), p=0.004; 4.0 (2.3-6.8) versus 2.6 (1.2-4.3), p=0.001, respectively]. Univariate analysis revealed that the severe FMR is a risk factor for PVR ≥3 and 5 WU [odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1-3.6, p=0.009; and OR: 3.2, 95% CI: 1.5-6.7, p=0.002]. The multivariate regression analysis results revealed that presence of severe FMR is an independent risk factor for PVR ≥3 WU and presence of combined pre-post-capillary PH (OR: 2.23, 95% CI: 1.30-3.82, p=0.003 and OR: 2.30, 95% CI: 1.25-4.26, p=0.008). Conclusion:Even in the updated definition of FMR with a lower threshold, severe FMR is associated with higher PVR, systolic PAP, and mean PAP and appears to have an unfavorable effect on pulmonary hemodynamics in patients with HT.

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Section: Discussionsupporting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Bayram

Doğan

Acar

et al. 2021

Anatolian J Cardiol

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“…If transplanted, post-transplant survival rates may approach the survival rates of noninfected individuals (35). The limitations to this strategy include the shortage of donor grafts (36)(37)(38)(39), and patient eligibility, as not all patients are eligible for heart transplantation due to elevated pulmonary vascular resistance, active malignancy, dysfunction of other organs, and other comorbidites (36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Device exchange versus nonexchange modalities in left ventricular assist device‐specific infections: A systematic review and meta‐analysis

et al. 2018

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No standardized treatment algorithm exists for the management of continuous‐flow left ventricular assist device (CF‐LVAD)‐specific infections. The aim of this systematic review and meta‐analysis was to compare the outcomes of CF‐LVAD‐specific infections as managed by device exchange to other treatment modalities not involving device exchange. Electronic search was performed to identify all studies in the English literature relating to the management of CF‐LVAD‐specific infections. All identified articles were systematically assessed for selection criteria. Thirteen studies with 158 cases of CF‐LVAD‐specific infection were pooled for analysis. Overall, 18/158 (11.4%) patients underwent CF‐LVAD exchange, and 140/158 (88.6%) patients were treated with non‐exchange modalities. The proportion of patients with isolated driveline infections or pump or pocket infections did not differ significantly between the groups. During a mean follow‐up of 290 days, there were no significant differences in the overall mortality [exchange 17.6% (4.3–50.6) vs. non‐exchange 23.3% (15.8–32.9), P = 0.67] and infection recurrence rates [exchange 26.7% (8.7–58.0) vs. non‐exchange 38.6% (15.4–68.5), P = 0.56]. In the setting of CF‐LVAD‐specific infections, device exchange does not appear to confer an advantage in the overall mortality and infection recurrence as compared to non‐exchange modalities.

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“…diabetes mellitus, renal dysfunction, cardiovascular disease, hypertension, prior malignancy etc. [8][9][10]. In order for older adults to be evaluated for transplantation, their life expectancy should be longer than the average time on the waitlist.…”

Section: Special Pre-transplant Considerations For Older Recipientsmentioning

confidence: 99%

Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations

Hemmersbach‐Miller¹,

Wolfe²,

Schmader³

2018

obm transplant

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In the U.S., older adults aged 65 or above comprise nearly one quarter of the solid organ transplant (SOT) waitlists, and the number of transplants performed in this age group continues to increase. There are no specific guidelines for the assessment and follow up of the older SOT candidate or recipient. Older adults are at increased risk of infectious complications after SOT. Despite these complications and even with the use of suboptimal donors, overall outcomes are favorable. We provide an overview to specific consideration as they relate to the older SOT candidate and recipient.

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Evaluation of a Heart Transplant Candidate

Cited by 20 publications

References 59 publications

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

How does severe functional mitral regurgitation redefined by European guidelines affect pulmonary vascular resistance and hemodynamics in heart transplant candidates?

Device exchange versus nonexchange modalities in left ventricular assist device‐specific infections: A systematic review and meta‐analysis

Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations

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