Impact of Pulmonary Vascular Resistances in Heart Transplantation for Congenital Heart Disease

Gazit, Avihu Z.; Canter, Charles E.

doi:10.2174/157340311797484213

Cited by 20 publications

(16 citation statements)

References 87 publications

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“…Furthermore, although some of the findings of our analysis could be anticipated from previous reports, our analysis provides a broad and integrated view of longitudinal changes in graft function in the contemporary RV dysfunction is an important determinant of early post-HT outcomes. 21,22 The mechanism of RV dysfunction in HT recipients is multifactorial. Donor brain death, graft ischemia, and elevated PVR have all been related to early RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Lunze

Colan

Gauvreau

et al. 2012

Circ: Cardiovascular Imaging

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Background-Allograft dysfunction is a common finding early after heart transplant (HT). We sought to assess the recovery of left (LV) and right ventricular (RV) function during the first year after HT in children and young adults using pulsedwave tissue Doppler imaging. Methods and Results-We analyzed serially performed echocardiography in 44 pediatric HT recipients (median age: 7.3 years at HT) who remained rejection-free during the first year post-transplant. Age-based normative values for systolic (S′), early-diastolic (E′), and late-diastolic (A′) velocities obtained using pulsed-wave tissue Doppler imaging in 380 healthy children were used to transform patient data into z scores. Pulsed-wave tissue Doppler imaging studies ≤10 days post-HT demonstrated biventricular systolic and diastolic dysfunction with most prominent impairment in RV systolic function (S′ z score −2.7±0.8), RV early-diastolic filling (E′ z score −2.3±1.1), and LV early-diastolic filling (E′ z score −2.3±1.1). LV systolic function (S′ z score) and late-diastolic filling (A′ z score) improved to normal in 11 to 30 days, LV early-diastolic filling (E′ z score) in 4 to 6 months, and RV early-diastolic filling in 6 to 9 months (P<0.001 for all on longitudinal analysis). However, RV systolic function (RV S′ z score −1.2±1.1) remained impaired 1-year post-transplant. Analysis of serial cardiac catheterization studies showed that RV and LV filling pressures were elevated early post-HT and declined gradually during the first year post-transplant. Conclusions-Pediatric

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Section: Discussionmentioning

confidence: 99%

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Lunze

Colan

Gauvreau

et al. 2012

Circ: Cardiovascular Imaging

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“…While guidelines recommend exclusion of patients with transpulmonary gradients greater than 15 mmHg, it is crucial to account for reversibility of elevated PVR with pulmonary vasodilators which may permit heart-alone transplant in higher pulmonary pressures situations (36).…”

Section: Pulmonary Vascular Resistance (Pvr)mentioning

confidence: 99%

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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The single ventricle patient population comprises the most complex cohort presenting to the cardiac transplant team, in terms of demographics, anatomic substrate, and unique physiology. It is also the most rapidly growing diagnostic group presenting for heart transplantation. In this manuscript, we aim to describe the changing landscape of transplantation in single ventricle conditions through reflection on our own institution's practice and experience, alongside contemporary literature review. Single ventricle patients are heterogeneous in terms of age, anatomic diagnosis and physiology according to surgical stage of repair.Progress in surgical palliative strategies has impacted upon the present composition of the population, with growing numbers of hypoplastic left heart syndrome patients and those with late physiology failure following Fontan completion. Multiple prior surgeries, immunological sensitivity and multi-organ involvement impart high peri-operative risk but can be mitigated in part by careful pre-operative planning by a dedicated multidisciplinary team addressing issues such as planning of concurrent reconstructive surgery, minimizing the post-operative effect of collaterals, timely harvesting, oversizing of donor organs to minimize graft failure, and strategies to address anticipated post-operative elevation in pulmonary vascular resistance. Determining optimal timing for transplant in these patients remains unclear, but understanding the risk of alternative surgical options can help guide decision making with regards to listing.

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“…oxygen‐based, Fick O2 ) states that the whole body utilization of oxygen is equal to the product of the arteriovenous oxygen content difference and cardiac output. In response to changes in PaO 2 , SvO 2 may change to a greater magnitude than arterial oxyhemoglobin saturation, narrowing the arteriovenous oxygen content difference and increasing Fick O2 estimates of CO. Fick O2 remains commonly used in critically ill infants and children with congenital heart disease, as well as in the cardiac catheterization laboratory, where it is used to estimate pulmonary vascular resistance and evaluate candidacy for cavopulmonary anastomosis or for heart transplantation . The majority of studies comparing Fick estimates to reference standard measurements, such as thermodilution, describe an overestimation of CO by Fick relative to reference standards, at times to a clinically and statistically significant degree .…”

Section: Introductionmentioning

confidence: 99%

Changes in tissue oxygen tension, venous saturation, and Fick‐based assessments of cardiac output during hyperoxia

Perry

Thomson

Pigula

et al. 2018

Acta Anaesthesiol Scand

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Impact of Pulmonary Vascular Resistances in Heart Transplantation for Congenital Heart Disease

Cited by 20 publications

References 87 publications

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Cardiac Allograft Function During the First Year after Transplantation in Rejection-Free Children and Young Adults

Transplantation in the single ventricle population

Changes in tissue oxygen tension, venous saturation, and Fick‐based assessments of cardiac output during hyperoxia

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