Original clinical scienceHeart transplantation in children with markedly elevated pulmonary vascular resistance: Impact of right ventricular failure on outcome
Section snippets
Methods
This was a retrospective record review of all patients who had heart transplantation at the Program for Pediatric Cardiomyopathy, Heart Failure and Transplantation of the Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, between June 1984 and January 2005. The study was approved by the Columbia University Institutional Review Board.
Pre-transplant data obtained included diagnoses, gender, age at transplantation, hemodynamic variables, and the amount
Statistical methods
Post-transplant outcomes, including incidence of RV failure, need for mechanical circulatory support (VAD or ECMO), and death from RV failure were compared between patients who had a high PVRI (≥ 6 IU) and those who had a low PVRI (< 6 IU). Additional analyses in the high PVRI group were performed to assess the influence of elevated pre-transplant PVRI, era of transplantation and post-transplant use of iNO on patient outcomes. Patients with elevated baseline PVRI were divided into 3 sub-groups
Pre-transplant characteristics
Between 1984 and 2005, 263 children and young adults received heart transplants, of which 58 (22%) had a baseline PVRI ≥ 6 IU. Table 1 compares the pre-transplant characteristics of the high and low PVRI groups. The high PVRI group was significantly older at the time of transplant and they had higher pre-transplant inotrope scores. The pre-transplant diagnoses of the high PVRI patients were congenital heart disease in 19 (33%), dilated cardiomyopathy in 26 (45%), hypertrophic cardiomyopathy in
Discussion
In this study we report an aggressive approach to the diagnosis and treatment of pulmonary hypertension in patients undergoing heart transplantation. A high proportion of patients (22%) who underwent transplant during the study period had baseline pulmonary hypertension. Survival was 71%, somewhat lower than would be expected but comparable to survival after transplant in patients with congenital heart disease.12 Significant controversy exists regarding heart transplantation in patients with
Disclosure statement
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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