Impact of postoperative pulmonary hypertension on outcome after heart transplantation.
OBJECTIVE
We wanted to investigate the effects of postoperative pulmonary hypertension (PHpostop: mean pulmonary artery pressure [MPAP] ≥ 25 mmHg), diastolic pressure gradient (DPG), pulmonary vascular resistance (PVR), and repeated hemodynamic measurements on long-term survival after heart transplantation (HT).


METHODS
Eighty-nine patients who underwent HT at Skåne University Hospital in Lund in the period 1988-2010 and who were evaluated with right-heart-catheterization at rest, prior to HT and repeatedly during the first postoperative year, were grouped based on their MPAP, DPG, and PVR.


RESULTS
One year after HT, survival was lower in patients with PHpostopthan in those without, in patients with DPG ≥7 mmHg than in those with DPG <7 mmHg, and in patients with PVR >3 WU than in those with PVR ≤3 WU. Moreover, compared to patients with no PHpostopor with PHpostopat one evaluation during the first year after HT, PHpostopat repeated evaluations was associated with higher mortality (hazard ratio 3.4, 95% CI 1.4-8.0). There was no significant difference in acute cellular rejection between patients with and without PHpostop, but postoperative kidney function was worse in patients with repeated PHpostop.


CONCLUSIONS
When defined according to present guidelines, PH one year after HT may emerge as a prognostic marker for long-term outcome after HT. Moreover, PHpostopat repeated evaluations during the first year after HT had stronger prognostic value than PHpostopat a single examination, illustrating a means of identifying a high-risk population. However, confirmation in larger multi-center studies is warranted.
a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.|b The Hemodynamics Laboratory, Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine , Skåne University Hospital , Lund , Sweden.
Jakob
J
Lundgren
a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.|b The Hemodynamics Laboratory, Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine , Skåne University Hospital , Lund , Sweden.
Carl
C
Söderlund
a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.|b The Hemodynamics Laboratory, Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine , Skåne University Hospital , Lund , Sweden.
Göran
G
Rådegran
D000293:Adolescent; D000328:Adult; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D055815:Young Adult
Diastolic pressure gradient; heart transplantation; pulmonary hypertension; pulmonary vascular resistance; right heart catheterization; survival