Aim of the study. Pulmonary hypertension is known to affect prognosis of cardiac allograft recipients. Aim of this study is to elucidate the mechanisms relating preoperative hemodynamics to early post-transplant mortality. Methods. Hemodynamic and pre- and postoperative clinical data of 122 heart transplant recipients were reviewed with respect to early mortality (within 1 month or in-hospital). The relationships between hemodynamics and mortality were studied by means of univariate and multivariate analysis of absolute data and at different out-off values of hemodynamic parameters. Results. The following hemodynamic parameters were significantly different between survivors (n = 107) and non-survivors (n = 15): right atrial pressure (7.7 ± 4.7 vs. 12.1 ± 8.6 mm Hg, p <0.004), pulmonary vascular resistance (2.57 ± 1.44 vs. 3.72 ± 1.88 Wood units, p <0.007), pulmonary vascular resistance index (4.43 ± 2.53 vs. 6.53 ± 3.28 Wood units x m2, p <0.005), and transpulmonary gradient (8.8 ± 4.8 vs. 12.3 ± 6.4 mm Hg, p <0.02). Right atrial pressure and pulmonary vascular resistance index showed an independent value at stepwise multiple logistic regression analysis (p <0.008 and <0.03 respectively). When mortality was tested using out-off values, it was significantly higher with right atrial pressure ≤ 12 (7/28 vs 8/94, p <0.05), pulmonary vascular resistance index ≤ 8 (6/13 vs 9/109, p <0.0005), and transpulmonary gradient ≤ 15 (5/13 vs 10/109, p <0.01). High right atrial pressure, pulmonary vascular resistance index, and transpulmonary gradient were associated with higher preoperative bilirubin (p <0.03), which was significantly superior in nonsurvivors (1.44 ± 1.53 vs. 0.83 ± 0.61 mg/dl, p <0.02). Postoperatively, severe right ventricular failure, severe renal failure and infections within 1 month were all strongly associated with an increased mortality (p <0.00003); they were more common in patients with high preoperative right filling pressure (9% vs. 43%, p <0.00002) and/or high pulmonary vascular resistance index (14% vs. 38%, p <0.03), in those with high right atrial pressure (9% vs. 35%, p <0.0009), and in those with high pulmonary vascular resistance index (17% vs. 58%, p <0.002) respectively. Mortality after acute rejection within 1 month was significantly higher in patients with high preoperative right atrial pressure (8% vs. 57%, p <0.006). Conclusions. Besides pulmonary hypertension, elevated preoperative right filling pressure appears to indicate an increased risk of early death after transplantation; pre- and postoperative end-organ dysfunction and post-transplant complications are more common or more threatening in this setting.
|Translated title of the contribution||Short-term survival after heart transplantation: Relationships between preoperative hemodynamics end-organ dysfunction and postoperative events|
|Number of pages||9|
|Journal||Giornale Italiano di Cardiologia|
|Publication status||Published - 1995|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine