Heart transplantation in children with markedly elevated pulmonary vascular resistance

Impact of right ventricular failure on outcome

George Ofori-Amanfo, Daphne T. Hsu, Jacqueline M. Lamour, Seema Mital, Michael L. O'Byrne, Arthur J. Smerling, Jonathan M. Chen, Ralph Mosca, Linda J. Addonizio

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Pulmonary hypertension causes increased morbidity and mortality in adults after heart transplantation. The effect of markedly elevated pulmonary vascular resistance (PVR) on post-transplant outcomes in children has not been well described. Methods: Outcomes were compared in a retrospective study between 58 children with an elevated PVR index (PVRI) < 6 U/m 2 and 205 children with a PVRI < 6 U/m2. Patients who did and did not respond to acute vasodilator testing and patients who underwent transplant before (pre-1995) and after (post-1995) the availability of inhaled nitric oxide (iNO) were compared. Results: The pre-transplant diagnoses, and cardiopulmonary bypass and donor ischemic times were similar between the high and low PVRI groups. High PVRI patients were older at transplant (12 ± 6.2 vs 8 ± 7.1 years, p = 0.002). The post-transplant inotrope score was higher in the high PVRI group (12 ± 12 vs 2 ± 2, p = 0.0001) and 1-year survival was worse (76% vs 81%, p = 0.03). The PVRI fell to < 6 U/m2 with acute vasodilator testing in 21 of 49 (42%) high PVRI patients. RV failure occurred in 4 (19%) of the responders and in 14 (50%) of the non-responders (p = 0.037). One responder (5%) and 4 non-responders (14%) died of RV failure. In the period after 1995, the year iNO became clinically available, the select group of high PVRI patients who received iNO preemptively had a lower incidence of post-transplant RV failure than the group that did not receive preemptive iNO (13% vs 54%, p = 0.04). Conclusions: Pre-transplant vasodilator testing identified patients at higher risk for RV failure. Patients who did not respond to vasodilator testing had an increased incidence of RV failure and death from RV failure. Preemptive use of iNO was associated with a decreased incidence of RV failure.

Original languageEnglish (US)
Pages (from-to)659-666
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Heart Transplantation
Vascular Resistance
Transplants
Nitric Oxide
Vasodilator Agents
Incidence
Cardiopulmonary Bypass
Pulmonary Hypertension
Retrospective Studies
Tissue Donors
Morbidity
Survival
Mortality

Keywords

  • heart transplantation
  • pulmonary hypertension
  • pulmonary vascular resistance
  • pulmonary vasodilator
  • right ventricular failure

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Heart transplantation in children with markedly elevated pulmonary vascular resistance : Impact of right ventricular failure on outcome. / Ofori-Amanfo, George; Hsu, Daphne T.; Lamour, Jacqueline M.; Mital, Seema; O'Byrne, Michael L.; Smerling, Arthur J.; Chen, Jonathan M.; Mosca, Ralph; Addonizio, Linda J.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 6, 06.2011, p. 659-666.

Research output: Contribution to journalArticle

Ofori-Amanfo, George ; Hsu, Daphne T. ; Lamour, Jacqueline M. ; Mital, Seema ; O'Byrne, Michael L. ; Smerling, Arthur J. ; Chen, Jonathan M. ; Mosca, Ralph ; Addonizio, Linda J. / Heart transplantation in children with markedly elevated pulmonary vascular resistance : Impact of right ventricular failure on outcome. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 6. pp. 659-666.
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AU - Hsu, Daphne T.

AU - Lamour, Jacqueline M.

AU - Mital, Seema

AU - O'Byrne, Michael L.

AU - Smerling, Arthur J.

AU - Chen, Jonathan M.

AU - Mosca, Ralph

AU - Addonizio, Linda J.

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N2 - Background: Pulmonary hypertension causes increased morbidity and mortality in adults after heart transplantation. The effect of markedly elevated pulmonary vascular resistance (PVR) on post-transplant outcomes in children has not been well described. Methods: Outcomes were compared in a retrospective study between 58 children with an elevated PVR index (PVRI) < 6 U/m 2 and 205 children with a PVRI < 6 U/m2. Patients who did and did not respond to acute vasodilator testing and patients who underwent transplant before (pre-1995) and after (post-1995) the availability of inhaled nitric oxide (iNO) were compared. Results: The pre-transplant diagnoses, and cardiopulmonary bypass and donor ischemic times were similar between the high and low PVRI groups. High PVRI patients were older at transplant (12 ± 6.2 vs 8 ± 7.1 years, p = 0.002). The post-transplant inotrope score was higher in the high PVRI group (12 ± 12 vs 2 ± 2, p = 0.0001) and 1-year survival was worse (76% vs 81%, p = 0.03). The PVRI fell to < 6 U/m2 with acute vasodilator testing in 21 of 49 (42%) high PVRI patients. RV failure occurred in 4 (19%) of the responders and in 14 (50%) of the non-responders (p = 0.037). One responder (5%) and 4 non-responders (14%) died of RV failure. In the period after 1995, the year iNO became clinically available, the select group of high PVRI patients who received iNO preemptively had a lower incidence of post-transplant RV failure than the group that did not receive preemptive iNO (13% vs 54%, p = 0.04). Conclusions: Pre-transplant vasodilator testing identified patients at higher risk for RV failure. Patients who did not respond to vasodilator testing had an increased incidence of RV failure and death from RV failure. Preemptive use of iNO was associated with a decreased incidence of RV failure.

AB - Background: Pulmonary hypertension causes increased morbidity and mortality in adults after heart transplantation. The effect of markedly elevated pulmonary vascular resistance (PVR) on post-transplant outcomes in children has not been well described. Methods: Outcomes were compared in a retrospective study between 58 children with an elevated PVR index (PVRI) < 6 U/m 2 and 205 children with a PVRI < 6 U/m2. Patients who did and did not respond to acute vasodilator testing and patients who underwent transplant before (pre-1995) and after (post-1995) the availability of inhaled nitric oxide (iNO) were compared. Results: The pre-transplant diagnoses, and cardiopulmonary bypass and donor ischemic times were similar between the high and low PVRI groups. High PVRI patients were older at transplant (12 ± 6.2 vs 8 ± 7.1 years, p = 0.002). The post-transplant inotrope score was higher in the high PVRI group (12 ± 12 vs 2 ± 2, p = 0.0001) and 1-year survival was worse (76% vs 81%, p = 0.03). The PVRI fell to < 6 U/m2 with acute vasodilator testing in 21 of 49 (42%) high PVRI patients. RV failure occurred in 4 (19%) of the responders and in 14 (50%) of the non-responders (p = 0.037). One responder (5%) and 4 non-responders (14%) died of RV failure. In the period after 1995, the year iNO became clinically available, the select group of high PVRI patients who received iNO preemptively had a lower incidence of post-transplant RV failure than the group that did not receive preemptive iNO (13% vs 54%, p = 0.04). Conclusions: Pre-transplant vasodilator testing identified patients at higher risk for RV failure. Patients who did not respond to vasodilator testing had an increased incidence of RV failure and death from RV failure. Preemptive use of iNO was associated with a decreased incidence of RV failure.

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