Prognosis after heart transplant in patients with pulmonary hypertension secondary to cardiopathy.
BACKGROUND
Pulmonary hypertension (PHT) is associated with greater posttransplant mortality. In the last few years, many vasodilator drugs have been developed and some patients have therefore been transplanted. However, conflicting data exist regarding the impact of reversible PHT on posttransplant outcomes. The aim of this study was to determine the evolution of our transplanted patients with reactive PHT and the causes of right cardiac insufficiency and perioperative mortality.


METHODS
We performed a retrospective analysis of 39 consecutive heart transplant recipients from January 2005 to December 2006. We analyzed significant pretransplant PHT, the percentage of emergency transplants, surgical technique, as well as ischemia and extracorporeal circulation times.


RESULTS
Before transplantation, significant PHT was present in 12 patients (30.8%), all of whom had a positive acute vasoreactivity test or response to oral treatment with pulmonary vasodilators. A nonsignificant tendency to increased posttransplant mortality was observed among patients with pretransplant PHT. We observed a significant increase in mortality in patients with prolonged operative times, over the third percentile, odds ratio (OR) for ECC of 21% (P = .001) and OR for prolonged ischemia time of 9.5% (P = .022). However, mortality did not increase significantly in cases of emergent transplantation (P = .08) or in the use of the Shumway bicaval surgical technique (P = .9).


CONCLUSIONS
There seemed to be a slight tendency to increased mortality among patients with reversible HTP, suggesting that high-risk patients need closer monitoring but are not absolutely contraindicated for transplantation.
Mogollón
M V
MV
Cardiology Service, Virgen del Rocio Hospital, Seville, Spain. mvmogjim@hotmail.com
Lage Gallé
E
E
Hinojosa Pérez
R
R
Herruzo Avilés
A
A
Sobrino Márquez
J M
JM
Romero Rodríguez
N
N
Martínez Martínez
A
A
D009202:Cardiomyopathies / Q000150:complications / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents