Predictors of mortality in patients with Eisenmenger syndrome and admission to the lung transplantation waiting list

Giovanna Callegari, A. M. D'Armini, P. Baiardi, M. Viganò, C. Fracchia

Research output: Contribution to journalArticle

Abstract

Background. Patients with Eisenmenger Syndrome (ES) have very severe irreversible pulmonary hypertension but the criteria for admitting such patients to a lung transplantation waiting list (LTWL) is not clear. Indeed it has been demonstrated that the natural survival of patients with ES is better than the survival achieved through lung transplantation: it follows that no guidelines are available for these patients' admission to an LTWL. The aim of our study was to identify possible predictors of mortality in ES patients in order to reserve admission to the LTWL solely for those patients who would otherwise have the lowest probability of survival. Methods. Since 1991, 57 patients with ES from our rehabilitative centre were admitted to the LTWL of the Division of Cardiac Surgery at San Matteo Hospital, University of Pavia. At the time of the retrospective analysis, patients were divided into a group of non-transplanted survivors (27 patients - 47% of the total) and a group who had died prior to transplantation (16 patients - 28% of the total). The 14 transplanted patients (25% of the total) were not considered in the statistical analysis, considering transplantation as an "external event". Unpaired t tests were used to compare the following factors in the survivors and in those who died: sex, "complexity" of the congenital heart disease underlying the ES, previous cardiac surgery, arterial blood gases, pulmonary function and hemodynamic parameters. Moreover, a stepwise discriminant analysis was performed in order to define a possible set of prognostic factors. Results. PaCO2 was higher in those who subsequently died (36.15±7.42 mmHg) compared with those who survived (32.5±5.33 mmHg), although this difference did not reach a statistical significance (p=0.08). Discriminant analysis defined a model in which a) complexity of the congenital heart disease, b) sex (male) and c) cardiac output were predictive of a higher risk of mortality. Conclusions. This new knowledge can be used in the decision of admission to LTWL in ES patients.

Original languageEnglish
Pages (from-to)199-202
Number of pages4
JournalMonaldi Archives for Chest Disease - Cardiac Series
Volume61
Issue number4
Publication statusPublished - Oct 2004

Fingerprint

Eisenmenger Complex
Waiting Lists
Lung Transplantation
Mortality
Discriminant Analysis
Thoracic Surgery
Survival
Survivors
Heart Diseases
Transplantation
Patient Admission
Pulmonary Hypertension
Cardiac Output

Keywords

  • Eisenmenger syndrome
  • Lung transplantation
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Predictors of mortality in patients with Eisenmenger syndrome and admission to the lung transplantation waiting list. / Callegari, Giovanna; D'Armini, A. M.; Baiardi, P.; Viganò, M.; Fracchia, C.

In: Monaldi Archives for Chest Disease - Cardiac Series, Vol. 61, No. 4, 10.2004, p. 199-202.

Research output: Contribution to journalArticle

@article{1cc8a675563b4efb94ce1a2203ba9286,
title = "Predictors of mortality in patients with Eisenmenger syndrome and admission to the lung transplantation waiting list",
abstract = "Background. Patients with Eisenmenger Syndrome (ES) have very severe irreversible pulmonary hypertension but the criteria for admitting such patients to a lung transplantation waiting list (LTWL) is not clear. Indeed it has been demonstrated that the natural survival of patients with ES is better than the survival achieved through lung transplantation: it follows that no guidelines are available for these patients' admission to an LTWL. The aim of our study was to identify possible predictors of mortality in ES patients in order to reserve admission to the LTWL solely for those patients who would otherwise have the lowest probability of survival. Methods. Since 1991, 57 patients with ES from our rehabilitative centre were admitted to the LTWL of the Division of Cardiac Surgery at San Matteo Hospital, University of Pavia. At the time of the retrospective analysis, patients were divided into a group of non-transplanted survivors (27 patients - 47{\%} of the total) and a group who had died prior to transplantation (16 patients - 28{\%} of the total). The 14 transplanted patients (25{\%} of the total) were not considered in the statistical analysis, considering transplantation as an {"}external event{"}. Unpaired t tests were used to compare the following factors in the survivors and in those who died: sex, {"}complexity{"} of the congenital heart disease underlying the ES, previous cardiac surgery, arterial blood gases, pulmonary function and hemodynamic parameters. Moreover, a stepwise discriminant analysis was performed in order to define a possible set of prognostic factors. Results. PaCO2 was higher in those who subsequently died (36.15±7.42 mmHg) compared with those who survived (32.5±5.33 mmHg), although this difference did not reach a statistical significance (p=0.08). Discriminant analysis defined a model in which a) complexity of the congenital heart disease, b) sex (male) and c) cardiac output were predictive of a higher risk of mortality. Conclusions. This new knowledge can be used in the decision of admission to LTWL in ES patients.",
keywords = "Eisenmenger syndrome, Lung transplantation, Mortality",
author = "Giovanna Callegari and D'Armini, {A. M.} and P. Baiardi and M. Vigan{\`o} and C. Fracchia",
year = "2004",
month = "10",
language = "English",
volume = "61",
pages = "199--202",
journal = "Monaldi Archives for Chest Disease",
issn = "1122-0643",
publisher = "Fondazione Salvatore Maugeri",
number = "4",

}

TY - JOUR

T1 - Predictors of mortality in patients with Eisenmenger syndrome and admission to the lung transplantation waiting list

AU - Callegari, Giovanna

AU - D'Armini, A. M.

AU - Baiardi, P.

AU - Viganò, M.

AU - Fracchia, C.

PY - 2004/10

Y1 - 2004/10

N2 - Background. Patients with Eisenmenger Syndrome (ES) have very severe irreversible pulmonary hypertension but the criteria for admitting such patients to a lung transplantation waiting list (LTWL) is not clear. Indeed it has been demonstrated that the natural survival of patients with ES is better than the survival achieved through lung transplantation: it follows that no guidelines are available for these patients' admission to an LTWL. The aim of our study was to identify possible predictors of mortality in ES patients in order to reserve admission to the LTWL solely for those patients who would otherwise have the lowest probability of survival. Methods. Since 1991, 57 patients with ES from our rehabilitative centre were admitted to the LTWL of the Division of Cardiac Surgery at San Matteo Hospital, University of Pavia. At the time of the retrospective analysis, patients were divided into a group of non-transplanted survivors (27 patients - 47% of the total) and a group who had died prior to transplantation (16 patients - 28% of the total). The 14 transplanted patients (25% of the total) were not considered in the statistical analysis, considering transplantation as an "external event". Unpaired t tests were used to compare the following factors in the survivors and in those who died: sex, "complexity" of the congenital heart disease underlying the ES, previous cardiac surgery, arterial blood gases, pulmonary function and hemodynamic parameters. Moreover, a stepwise discriminant analysis was performed in order to define a possible set of prognostic factors. Results. PaCO2 was higher in those who subsequently died (36.15±7.42 mmHg) compared with those who survived (32.5±5.33 mmHg), although this difference did not reach a statistical significance (p=0.08). Discriminant analysis defined a model in which a) complexity of the congenital heart disease, b) sex (male) and c) cardiac output were predictive of a higher risk of mortality. Conclusions. This new knowledge can be used in the decision of admission to LTWL in ES patients.

AB - Background. Patients with Eisenmenger Syndrome (ES) have very severe irreversible pulmonary hypertension but the criteria for admitting such patients to a lung transplantation waiting list (LTWL) is not clear. Indeed it has been demonstrated that the natural survival of patients with ES is better than the survival achieved through lung transplantation: it follows that no guidelines are available for these patients' admission to an LTWL. The aim of our study was to identify possible predictors of mortality in ES patients in order to reserve admission to the LTWL solely for those patients who would otherwise have the lowest probability of survival. Methods. Since 1991, 57 patients with ES from our rehabilitative centre were admitted to the LTWL of the Division of Cardiac Surgery at San Matteo Hospital, University of Pavia. At the time of the retrospective analysis, patients were divided into a group of non-transplanted survivors (27 patients - 47% of the total) and a group who had died prior to transplantation (16 patients - 28% of the total). The 14 transplanted patients (25% of the total) were not considered in the statistical analysis, considering transplantation as an "external event". Unpaired t tests were used to compare the following factors in the survivors and in those who died: sex, "complexity" of the congenital heart disease underlying the ES, previous cardiac surgery, arterial blood gases, pulmonary function and hemodynamic parameters. Moreover, a stepwise discriminant analysis was performed in order to define a possible set of prognostic factors. Results. PaCO2 was higher in those who subsequently died (36.15±7.42 mmHg) compared with those who survived (32.5±5.33 mmHg), although this difference did not reach a statistical significance (p=0.08). Discriminant analysis defined a model in which a) complexity of the congenital heart disease, b) sex (male) and c) cardiac output were predictive of a higher risk of mortality. Conclusions. This new knowledge can be used in the decision of admission to LTWL in ES patients.

KW - Eisenmenger syndrome

KW - Lung transplantation

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=18044376985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=18044376985&partnerID=8YFLogxK

M3 - Article

C2 - 15909608

AN - SCOPUS:18044376985

VL - 61

SP - 199

EP - 202

JO - Monaldi Archives for Chest Disease

JF - Monaldi Archives for Chest Disease

SN - 1122-0643

IS - 4

ER -