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Ann Thorac Surg 2006;82:1770-1773
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Reversible Pulmonary Hypertension in Heart Transplant Candidates: To Transplant or Not to Transplant

^a Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany
^b Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany

Accepted for publication May 25, 2006.

^_* Address correspondence to Dr Klotz, Department of Thoracic- and Cardiovascular Surgery, University Hospital Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany (Email: stefan.klotz{at}ukmuenster.de).

Presented at the Poster Session of the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, Jan 30–Feb 1, 2006.

BACKGROUND: Pulmonary hypertension (PHT), defined as a pulmonary vascular resistance (PVR) greater than 2.5 Wood units [WU] and(or) transpulmonary gradient (TPG) greater than 12 mm Hg, is a risk factor for mortality in cardiac transplantation due to elevated postoperative right heart failure. Orthotopic heart transplantation is possible if PVR could be reversed below 2.5 WU and TPG below 12 mm Hg. We show the Muenster experience from the last 10 years.

METHODS: From April 1996 to December 2005 all cardiac transplant recipients separated into patients with and without PHT were included. All patients with PHT had successful reduction (PVR 2.5 WU and TPG 12 mm Hg) using prostaglandin I₂ or E₁. Posttransplant early and late mortality and incidence of right heart failure were studied.

RESULTS: Two hundred seventeen patients were included in this study. Of these, 168 had normal pulmonary pressures (non-PHT group), 49 (22.6%) had reversible PHT (rev-PHT group). Mean PVR was 1.6 ± 1.1 WU vs 2.1 ± 1.1 WU (p < 0.01; non-PHT vs rev-PHT) and mean TPG 8.0 ± 1.9 mm Hg vs 10.6 ± 4.1 mm Hg (p = not significant [NS]). Thirty-day survival after orthotopic cardiac transplantation was 85% vs 78% (p = 0.150) and 10 year survival 63% vs 61% (p = NS). Right heart failure during the first 30 days after transplantation occurred in 27% in the non-PHT group and in 64% in the rev-PHT group (p = 0.035). However, in patients transplanted after 2001 it did not appear.

CONCLUSIONS: Cardiac transplant candidates with reversible PHT have still significantly elevated pulmonary pressures compared with patients without PHT. Despite a significantly higher risk of right heart failure, long-term survival after orthotopic cardiac transplantation was not affected.

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