title: Severe right heart failure after heart transplantation. A single-center experience.
abstract: We reviewed our heart transplantation recipient population, using hard criteria defining severe right heart failure (RHF), and analyzed possible risk factors for outcome after RHF. Between 1983 and 1998 621 cardiac transplantations were performed at our institution. RHF was defined by the necessity to implant an assist device or echocardiographically confirmed right ventricular ballooning with concomitant end organ failure. RHF patients were compared with a matched control group. Thirty-five patients (5.9%) with severe RHF after transplantation fulfilled inclusion criteria. Of these, 32 patients died, while none of the control patients died (P < 0.001). Increased preoperative pulmonary capillary wedge (P = 0.005) and mean pulmonary artery pressure (P = 0.006) were identified as significant risk factors for severe RHF. Severe RHF as defined in our study is irreversible in almost every case without differences among therapeutical concepts. Hence, improvement of postoperative outcome necessitates avoidance or aggressive therapy of possible risk factors.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. klima@thg.mh-hannover.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Klima
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ringes-Lichtenberg
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors