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Impact of postoperative pulmonary hypertension on outcome after heart transplantation

Lundgren, Jakob LU ; Söderlund, Carl LU and Rådegran, Göran LU (2017) In Scandinavian Cardiovascular Journal 51(3). p.172-181
Abstract

Objectives: 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). Design: 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 PHpostop than in those without, in patients with DPG ≥7 mmHg... (More)

Objectives: 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). Design: 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 PHpostop than 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 PHpostop or with PHpostop at one evaluation during the first year after HT, PHpostop at 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, PHpostop at repeated evaluations during the first year after HT had stronger prognostic value than PHpostop at a single examination, illustrating a means of identifying a high-risk population. However, confirmation in larger multi-center studies is warranted.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Diastolic pressure gradient, heart transplantation, pulmonary hypertension, pulmonary vascular resistance, right heart catheterization, survival
in
Scandinavian Cardiovascular Journal
volume
51
issue
3
pages
10 pages
publisher
Taylor & Francis
external identifiers
  • wos:000399591800008
  • pmid:28326855
  • scopus:85015958962
ISSN
1401-7431
DOI
10.1080/14017431.2017.1304569
language
English
LU publication?
yes
id
5fd586b5-ff4c-4c42-b059-e4d8b08f9c12
date added to LUP
2017-05-03 17:25:30
date last changed
2025-01-07 12:29:40
@article{5fd586b5-ff4c-4c42-b059-e4d8b08f9c12,
  abstract     = {{<p>Objectives: We wanted to investigate the effects of postoperative pulmonary hypertension (PH<sub>postop</sub>: 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). Design: 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 PH<sub>postop</sub> than in those without, in patients with DPG ≥7 mmHg than in those with DPG &lt;7 mmHg, and in patients with PVR &gt;3 WU than in those with PVR ≤3 WU. Moreover, compared to patients with no PH<sub>postop</sub> or with PH<sub>postop</sub> at one evaluation during the first year after HT, PH<sub>postop</sub> at 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 PH<sub>postop</sub>, but postoperative kidney function was worse in patients with repeated PH<sub>postop</sub>. 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, PH<sub>postop</sub> at repeated evaluations during the first year after HT had stronger prognostic value than PH<sub>postop</sub> at a single examination, illustrating a means of identifying a high-risk population. However, confirmation in larger multi-center studies is warranted.</p>}},
  author       = {{Lundgren, Jakob and Söderlund, Carl and Rådegran, Göran}},
  issn         = {{1401-7431}},
  keywords     = {{Diastolic pressure gradient; heart transplantation; pulmonary hypertension; pulmonary vascular resistance; right heart catheterization; survival}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{3}},
  pages        = {{172--181}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Cardiovascular Journal}},
  title        = {{Impact of postoperative pulmonary hypertension on outcome after heart transplantation}},
  url          = {{http://dx.doi.org/10.1080/14017431.2017.1304569}},
  doi          = {{10.1080/14017431.2017.1304569}},
  volume       = {{51}},
  year         = {{2017}},
}