Portal de Periódicos da CAPES

Pre-existing Pulmonary Hypertension in Patients With End-stage Heart Failure: Impact on Clinical Outcome and Hemodynamic Follow-up After Orthotopic Heart Transplantation

2007; Elsevier BV; Volume: 26; Issue: 4 Linguagem: Inglês

10.1016/j.healun.2006.12.012

1557-3117

Sorel Goland, L. Czer, Robert M. Kass, Michele A. De Robertis, James Mirocha, Bernice Coleman, Christopher Capelli, Sharo Raissi, Wen Cheng, Gregory P. Fontana, Alfredo Trento,

Pulmonary Hypertension Research and Treatments

Background The purpose of this investigation was to determine the influence of pre-existing pulmonary hypertension (PHT) on outcome and to assess the pulmonary hemodynamic changes after heart transplantation (HT). Methods A total of 410 patients were studied before and after (1 month and 1 year) HT: Group 1 ( n = 266) had no PHT (PVR < 3 Wood units [WU], TPG < 10 mm Hg); Group 2 ( n = 112) had mild–moderate PHT (PVR 3 to 6 WU, TPG 10 to 20 mm Hg); and Group 3 ( n = 32) had severe PHT (PVR > 6 WU, TPG > 20 mm Hg). Results Mean (± SD) follow-up was 5.2 ± 4.1 years, mean recipient age was 57 ± 11, and mean donor age was 30 ± 12 years. Baseline characteristics were similar in all groups, except donor/recipient weight ratio, which was higher in patients with PHT ( p = 0.002). There was a significant ( p < 0.0001) decrease in mean TPG to 11.0 within the first month and to 9.5 mm Hg after the first year. Decreases in PVR to 2.2 and 2.0 WU at 1 month and 1 year, respectively ( p < 0.0001 for both) were also found. Reversibility (after vasodilation) of PHT was obtained in 85% of patients in Group 2 and in 84% in Group 3. Patients' PHT did not show a significant difference in 30-day mortality ( p = 0.9) and long-term survival ( p = 0.8). Patients with residual post-transplant PHT (PVR ≥ 3 WU) had reduced long-term survival ( p = 0.03). Multivariate analysis showed no evidence that elevated PVR was associated with death. Conclusions Pre-existing elevated PVR that responds to vasodilator challenge does not have a negative influence on short- and long-term survival after HT. We found that residual post-transplant PHT is associated with decreased long-term survival.