Impact of fixed pulmonary hypertension on post–heart transplant outcomes in bridge-to-transplant patients

Alba, Ana C.; Rao, Vivek; Ross, Heather J.; Jensen, Annette Schophuus; Sander, Kaare; Gustafsson, Finn; Delgado, Diego

doi:10.1016/j.healun.2010.06.002

Cited by 81 publications

(51 citation statements)

References 23 publications

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“…Echocardiography can reveal subclinical HF and predict risk of subsequent events. [291][292][293][294][295] Use of echocardiograms in patients with suspected HF improves disease identification and provision of appropriate medical care. 296 Echocardiographic evaluation should address whether LVEF is reduced, LV structure is abnormal, and other structural abnormalities are present that could account for the clinical presentation.…”

Section: October 15 2013mentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

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Section: October 15 2013mentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of Heart Failure

et al. 2013

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“…31,32 LVAD therapy has demonstrated efficacy in reducing fixed PH and permits patients to undergo HT. [14][15][16][17] Unloading the left ventricle decreases PCWP, thereby inducing a decline in the PAP. In addition, improved CO reduces hypoxia at the tissue level, resulting in less pulmonary vasoconstriction.…”

Section: Figurementioning

confidence: 99%

“…33 Of interest, in 1 of these studies, up to 28% of the patients who received LVAD support also received sildenafil therapy. 15 Two recent studies including patients with fixed PH have demonstrated that LVAD therapy significantly decreases PH, even in patients with fixed PH, allowing candidacy for HT. 15,26 In those studies, the presence of fixed PH did not reduce post-HT survival.…”

Section: Figurementioning

confidence: 99%

“…15 Two recent studies including patients with fixed PH have demonstrated that LVAD therapy significantly decreases PH, even in patients with fixed PH, allowing candidacy for HT. 15,26 In those studies, the presence of fixed PH did not reduce post-HT survival. Of interest, pre-LVAD hemodynamic values in these studies were respectively similar to our cohort of patients with fixed PH (MPAP: 39 Ϯ 7 and 42 Ϯ 13 vs 44 Ϯ 13 mm Hg; TPG: 16 Ϯ 4 and 20 Ϯ 6 vs 17 Ϯ 3; PVR: 4.3 Ϯ 1.7 and 4.8 Ϯ 1.8 vs 5.0 Ϯ 1.1).…”

Section: Figurementioning

confidence: 99%

“…[9][10][11][12][13] The reversibility of fixed PH by the use of left ventricular assist device (LVAD) support has recently been demonstrated. [14][15][16][17] However, having a less aggressive and simpler therapy to reduce severe PH and allow HT would be of a great value.…”

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confidence: 99%

See 2 more Smart Citations

Effects of chronic sildenafil use on pulmonary hemodynamics and clinical outcomes in heart transplantation

Pons¹,

Leblanc²,

Bernier³

et al. 2012

The Journal of Heart and Lung Transplantation

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Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

et al. 2020

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Aims Severely elevated pre‐transplant pulmonary vascular resistance (PVR) has been linked to adverse effects after heart transplantation (HTX). The impact of a moderately increased PVR before HTX on post‐transplant outcomes remains uncertain. The aim of this study was to investigate the effects of an elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) on outcomes after HTX. Methods and results This observational retrospective single‐centre study included 561 patients receiving HTX at Heidelberg Heart Center between 1989 and 2015. Patients were stratified by degree of pre‐transplant PVR. Analyses covered demographics, post‐transplant medication, mortality and causes of death after HTX, early post‐transplant atrial fibrillation (AF), and length of the initial hospital stay after HTX. Ninety‐four patients (16.8%) had a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). These patients had a higher rate of early post‐transplant AF [20.2 vs. 10.7%, difference: 9.5%, 95% confidence interval (CI): 0.9–18.1%, P = 0.01] and an increased 30 day post‐transplant mortality (25.5 vs. 6.4%, hazard ratio: 4.4, 95% CI: 2.6–7.6, P < 0.01), along with a higher percentage of death due to transplant failure (21.2 vs. 4.1%, difference: 17.1%, 95% CI: 8.7–25.5%, P < 0.01). Multivariate analysis revealed a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) as a significant risk factor for increased 30 day mortality after HTX (hazard ratio: 4.4, 95% CI: 2.5–7.6, P < 0.01). Kaplan–Meier estimator showed a lower 2 year survival after HTX (P < 0.01) in patients with a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). Conclusions Elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) is associated with early post‐transplant AF and increased mortality after HTX.

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Impact of fixed pulmonary hypertension on post–heart transplant outcomes in bridge-to-transplant patients

Cited by 81 publications

References 23 publications

2013 ACCF/AHA Guideline for the Management of Heart Failure

2013 ACCF/AHA Guideline for the Management of Heart Failure

Effects of chronic sildenafil use on pulmonary hemodynamics and clinical outcomes in heart transplantation

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

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