Hypotension, acidosis and vasodilation syndrome after heart transplant: incidence, risk factors, and prognosis.
BACKGROUND
HAV syndrome, the combination of hypotension, acidosis and vasodilation (HAV), is a serious postoperative complication after heart transplantation (HT). Its etiology and prognosis are poorly understood.


OBJECTIVE
To determine the incidence and prognosis of post-HT HAV syndrome and examine possible risk factors.


METHODS
Retrospective examination of the records of 85 consecutive patients who underwent HT between December 1999 and June 2002 sought the HAV criteria: systolic BP <85 mm Hg plus HCO3 <19 mEq/l whole excluding cardiogenic, hypovolemic and septic shock. Donor variables included sex, age, weight, height, cause of death, time in ICU, and ischemic time; while recipient variables, sex, age, weight, height, etiology of cardiopathy, previous cardiopulmonary bypass surgery, preoperative amiodarone, beta-blockers, catecholamines, mechanical ventilation or intra aortic balloon pump (IABP), RVP, time on waiting list, pump time, reoperations, polytransfusion, preoperative creatinine, GOT, GPT and GGT, induction with OKT3 or anti-CD25, bypass-to-HAV time, duration of catecholamine treatment, and 1 month survival after HT.


RESULTS
The 11 HAV cases (13%) appeared between 1 and 72 h after HT (75% in the first hour). Catecholamines were used for 1 to 6 days; control was achieved within 48 h in 58% of cases. Two HAV patients (18%) died within the first month versus six non-HAV patients (8.1%) (P=.275). Only polytransfusion showed more than a borderline value to predict HAV syndrome.


CONCLUSIONS
HAV syndrome has an incidence of 13% and a mortality of 18% within 1 month post-HT. The only likely risk factor is polytransfusion.
Paniagua
M J
MJ
Heart Transplant Programme, Juan Canalejo University Hospital Complex, A Coruña, Spain.
Crespo-Leiro
M G
MG
Muñiz
J
J
Vázquez
E
E
Tabuyo
T
T
Castro-Orjales
M
M
Fojon
S
S
López
J M
JM
Garrido
I P
IP
Juffé
A
A
Castro-Beiras
A
A
D000138:Acidosis / Q000453:epidemiology / Q000209:etiology*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000704:Analysis of Variance; D001639:Bicarbonates / Q000097:blood; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors; D014664:Vasodilation / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D001639:Bicarbonates