Impact of Preoperative Pulmonary Hypertension on Survival in Patients Undergoing Elective Heart Transplant

Cantero-Pérez, E.M.; Sayago, Inés; Sobrino-Márquez, José Manuel; Rangel‐Sousa, Diego; Grande‐Trillo, Antonio; Rezaei, Kambiz; Adsuar-Gómez, Alejandro

doi:10.1016/j.transproceed.2019.11.034

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…The distinction between reversible and irreversible changes in PVR is crucial for OHT candidates [1,[3][4][5]. The ISHLT guidelines suggest that sPAP > 60 mmHg, PVR > 5 Wood or TPG > 16-20 mmHg represent a high risk for postoperative RV failure and may result in 30-day mortality [6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension

Dyla

Mielnicki²,

Waszak

et al. 2022

IJERPH

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Pulmonary hypertension (PH) constitutes one of the main contraindications to heart transplantation (OHT), and elevated pulmonary vascular resistance (PVR) is associated with high risk of posttransplant right heart failure (RVF). In the present case report, a patient with PH is introduced who qualified for heart lung transplantation (HLT) and underwent successful OHT with temporary right ventricle assist device (tRVAD) due to the lack of a suitable heart-lung donor. Temporary RVAD support coupled with optimal medical management may help reverse pulmonary vascular resistance, which was previously deemed as permanent in patients requiring heart transplantation.

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Section: Discussionmentioning

confidence: 99%

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension

Dyla

Mielnicki²,

Waszak

et al. 2022

IJERPH

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“…In adult patients undergoing heart transplantation, pulmonary hypertension and consequent right heart failure is a life-threatening complication. 45 Breathing NO reduced pulmonary hypertension and improved right heart function 46 in this clinical setting.…”

Section: Perioperative Pulmonary Hypertension After Cardiac Surgerymentioning

confidence: 93%

Therapeutic Gases and Inhaled Anesthetics as Adjunctive Therapies in Critically Ill Patients

Gianni

Valsecchi

2022

Semin Respir Crit Care Med

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The administration of exogenous oxygen to support adequate gas exchange is the cornerstone of respiratory care. In the past few years, other gaseous molecules have been introduced in clinical practice to treat the wide variety of physiological derangement seen in critical care patients.Inhaled nitric oxide (NO) is used for its unique selective pulmonary vasodilator effect. Recent studies showed that NO plays a pivotal role in regulating ischemia-reperfusion injury and it has antibacterial and antiviral activity.Helium, due to its low density, is used in patients with upper airway obstruction and lower airway obstruction to facilitate gas flow and to reduce work of breathing.Carbon monoxide (CO) is a poisonous gas that acts as a signaling molecule involved in many biologic pathways. CO's anti-inflammatory and antiproliferative effects are under investigation in the setting of acute respiratory distress and idiopathic pulmonary fibrosis.Inhaled anesthetics are widely used in the operative room setting and, with the development of anesthetic reflectors, are now a valid option for sedation management in the intensive care unit.Many other gases such as xenon, argon, and hydrogen sulfide are under investigation for their neuroprotective and cardioprotective effects in post-cardiac arrest syndrome.With all these therapeutic options available, the clinician must have a clear understanding of the physiologic basis, therapeutic potential, and possible adverse events of these therapeutic gases. In this review, we will present the therapeutic gases other than oxygen used in clinical practice and we will describe other promising therapeutic gases that are in the early phases of investigation.

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“…Several studies have shown that even mild degree of pretransplant PH may adversely influence survival after CTx, while it had no impact in others (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Data from the United Network for Organ Sharing (UNOS) registry showed that a PVR ≥ 2.5 woods units (WU) was a significant risk factor for early mortality, but not for 10-year mortality (19).…”

Section: Introductionmentioning

confidence: 99%

Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation

Nasri

Dupuis

Carrier

et al. 2022

Front. Cardiovasc. Med.

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AimTo investigate the effect of the new definition of pulmonary hypertension (PH) and new pulmonary vascular resistance (PVR) thresholds on the prevalence, clinical characteristics, and events following cardiac transplantation (CTx) over 30 years.MethodsPatients who underwent CTx between 1983 and 2014 for whom invasive hemodynamic data was available were analyzed (n = 342). Patients transplanted between 1983 and 1998 were classified as early era and those transplanted between 1999 and 2014 were classified as recent era. Group 2 PH was diagnosed in the presence of a mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. Isolated post capillary PH (Ipc-PH) was defined as PVR ≤ 2 wood units and combined pre and post capillary PH (Cpc-PH) was defined PVR > 2 wood units. Moderate to severe PH was defined as mPAP ≥ 35 mmHg. The primary outcome was 30-day mortality and long-term mortality according to type and severity of PH. Proportions were analyzed using the chi-square test, and survival analyses were performed using Kaplan-Meier curves and compared using the logrank test.ResultsThe prevalence of PH in patients transplanted in the early era was 89.1%, whilst 84.2% of patients transplanted in the recent era had PH (p = 0.3914). There was no difference in the prevalence of a pre-capillary component according to era (p = 0.4001), but severe PH was more common in the early era (51.1% [early] vs 38.0% [recent] p = 0.0151). Thirty-day and long-term mortality were not significantly associated with severity or type of PH. There was a trend toward increased 30-day mortality in mild PH (10.1%), compared to no PH (4.4%) and moderate to severe PH (6.6%; p = 0.0653). Long-term mortality did not differ according to the severity of PH (p = 0.1480). There were no significant differences in 30-day or long-term mortality in IpcPH compared to CpcPH (p = 0.3974 vs p = 0.5767, respectively).ConclusionOver 30 years, PH has remained very prevalent before CTx. The presence, severity, and type (pre- vs post-capillary) of PH is not significantly associated with short- or long-term mortality.

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Impact of Preoperative Pulmonary Hypertension on Survival in Patients Undergoing Elective Heart Transplant

Cited by 5 publications

References 10 publications

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension

A Successful Heart Transplantation Coupled with Temporary Right Ventricular Assist Device Implantation in a Patient with (ir)Reversible Pulmonary Hypertension

Therapeutic Gases and Inhaled Anesthetics as Adjunctive Therapies in Critically Ill Patients

Thirty-year trends and outcome of isolated versus combined group 2 pulmonary hypertension after cardiac transplantation

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