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 language | English (US) |
|---|---|
| Pages (from-to) | 659-666 |
| Number of pages | 8 |
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 30 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2011 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Heart transplantation in children with markedly elevated pulmonary vascular resistance
T2 - Impact of right ventricular failure on outcome
AU - Ofori-Amanfo, George
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.
PY - 2011/6
Y1 - 2011/6
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.
KW - heart transplantation
KW - pulmonary hypertension
KW - pulmonary vascular resistance
KW - pulmonary vasodilator
KW - right ventricular failure
UR - http://www.scopus.com/inward/record.url?scp=79955824946&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955824946&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2010.12.007
DO - 10.1016/j.healun.2010.12.007
M3 - Article
VL - 30
SP - 659
EP - 666
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 6
ER -