[Hemodynamic characteristics of heart transplant patients in the early postoperative period].
In spite of good long-term results, heart transplantation continues to carry a significant risk of hospital mortality (about 10%). Among cardiac deaths, right-heart failure due to an elevated pulmonary vascular resistance represents a main contributing factor. Since no quantitative data on the hemodynamic situation early after transplantation are available, we monitored 27 heart transplant patients during the first four postoperative days. Data derived from right-heart catheterization, dosages of catecholamines and vasodilative substances were measured at 2, 4, 16, 24, 48, 72, and 96 h after the operation. Oxygen consumption and serum lactate levels were determined until 48 h postoperatively. During that time cardiac output remained constant (2 h: 6.6 +/- 1.4 l/min). The dosage of catecholamines was highest immediately after transplantation (2 h: 0.229 +/- 0.136 micrograms adrenaline/kg/min) and could be reduced thereafter. Highest values of pulmonary vascular resistance were obtained 2 h postoperatively (160 +/- 48 dyn.s.cm-5). This early postoperative situation may result in the development of right-heart failure as observed in two patients who died despite the use of prostacycline on the third and eighth postoperative days. To counteract the systemic vasodilative side-effects of prostaglandins, temporary atrial pacing seems to be useful. In our study atrial stimulation led to an increase of cardiac output and a moderate elevation of mean arterial blood pressure. Only a poor correlation between pre- and postoperative (2-h) pulmonary vascular resistance data could be observed. In most patients the pulmonary vascular resistance decreased during the postoperative course. This was not the case in patients with fixed pulmonary hypertension. We, therefore, conclude that preoperative diagnostics should be refined to recognize patients at risk in order to reduce postoperative mortality.
Dammenhayn
L
L
Medizinische Hochschule Hannover, Klinik für Thorax-, Herz- und Gefässchirurgie.
Haverich
A
A
Coppola
R
R
Albes
J
J
Cremer
J
J
Schäfers
H J
HJ
Wahlers
T
T
D000328:Adult; D011464:Epoprostenol / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology*; D012307:Risk Factors; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
D007773:Lactates; D019344:Lactic Acid; D011464:Epoprostenol; D010100:Oxygen
Das Kreislaufverhalten herztransplantierter Patienten in der frühen postoperativen Phase.