Kahraman YAKUT, Birgül VARAN, İlkay ERDOĞAN, Nimet CİNDİK, Mahmut GÖKDEMİR, Ayten GÜMÜŞ, Kürşad TOKEL, Atilla SEZGİN
Management of pediatric cardiac transplantation candidates with pulmonary hypertension and high pulmonary vascular resistance
Background and objectives. Right ventricular failure is an important cause of mortality and morbidity after orthotopic heart transplantation (OHT). The right ventricle of the donor may fail to accommodate to the high pulmonary vascular resistance (PVR) of the recipient. Pulmonary hypertension (PH) due to chronic heart failure with PVRi > 4 Wood units.m2, transpulmonary gradient > 15 mmHg adversely affect the outcome of OHT. In this study we aimed to evaluate management strategies in our pediatric cardiac transplantation candidates with PH and high PVR prior to OHT. Method. Twenty-six cardiac transplantation candidates (age: 10.2 ± 4.6, 1-17 years) underwent cardiac catheterization for the determination of PVR and pulmonary arterial pressure. They were admitted to the hospital and received 1-3 days of intravenous (IV) vasodilator therapy; 0.5-3 μg/kg/min nitroglyserin and/or 0.5-3 μg/kg/min nitroprusside, 5-15 μg/kg/min dobutamin and/or dopamin to keep systolic blood pressure above 80 mmHg. Results. Thirteen patients had dilated cardiomyopathy (CMP), 11 had restrictive CMP, one had hypertrophic CMP and one had congenital heart disease (CHD). Nineteen of the 26 patients underwent OHT. Mean pulmonary arterial pressure of the patients ranged between 11 and 82 mmHg (30.4 ± 16 mmHg) and PVRi between 0.41-21.4 Wood units.m2 (5.3 ± 5.7). Nine patients had PVRi above 4 Wood units.m2. Six of these patients had IV treatment for longer than three days and some received specific anti-PH treatment. Eventually they underwent a pulmonary vasoreactivity test with IV iloprost and six had PVRi
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1. Hosenpud JD, Bennett LE, Keck BM, Boucek MM, Novick RJ. The Registry of the International Society for Heart and Lung Transplantation: seventeenth official report-2000. J Heart Lung Tranplant 2000; 19: 909-931.2. Hoskote A, Carter C, Rees P, Elliott M, Burch M, Brown K. Acute right ventricular failure after pediatric cardiac transplant: predictors and longterm outcome in current era of transplantation medicine. J Thorac Cardiovasc Surg 2010; 139: 146- 153.
3. Huang J, Trinkaus K, Huddleston CB, Mendeloff EN, Spray TL, Canter CE. Risk factors for primary graft failure after pediatric cardiac transplantation: importance of recipient and donor characteristics. J Heart Lung Transplant 2004; 23: 716-722.
4. Costard-Jäckle A, Fowler MB. Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group. J Am Coll Cardiol 1992; 19: 48-54.
5. Mancini D, Lietz K. Selection of cardiac transplantation candidates in 2010. Circulation 2010; 122: 173-183.
6. Muthialu N. Orthotopic heart transplantation in children. Asian Cardiovasc Thorac Ann 2018; 26: 277-284.
7. Lundgren J, Söderlund C, Rådegran G. Impact of postoperative pulmonary hypertension on outcome after heart transplantation. Scand Cardiovasc J 2017; 51: 172-181.
8. Haywood GA, Sneddon JF, Bashir Y, Jennison SH, Gray HH, McKenna WJ. Adenosine infusion for the reversal of pulmonary vasoconstriction in biventricular failure: a good test but a poor therapy. Circulation 1992; 86: 896-902.
9. Mahajan A, Shabanie A, Varshney SM, Marijic J, Sopher MJ. Inhaled nitric oxide in the preoperative evaluation of pulmonary hypertension in heart transplant candidates. J Cardiothorac Vasc Anesth 2007; 21: 51-56.
10. Murali S, Uretsky BF, Reddy PS, Tokarczyk TR, Betschart AR. Reversibility of pulmonary hypertension in congestive heart failure patients evaluated for cardiac transplantation: comparative effects of various pharmacologic agents. Am Heart J 1991; 122: 1375-1381.
11. Daftari B, Alejos JC, Perens G. Initial experience with sildenafil, bosentan, and nitric oxide for pediatric cardiomyopathy patients with elevated pulmonary vascular resistance before and after orthotopic heart transplantation. J Transplant 2010; 2010: 656984.
12. Chiu P, Schaffer JM, Sheikh AY, et al. Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: a retrospective analysis of the UNOS database. Pediatr Transplant 2015; 19: 623-633.
13. Richmond ME, Law YM, Das BB, et al; Pediatric Heart Transplant Study Investigators. Elevated pre-transplant pulmonary vascular resistance is not associated with mortality in children without congenital heart disease: a multicenter study. J Heart Lung Transplant 2015; 34: 448-456.
14. Addonizio LJ, Gersony WM, Robbins RC, et al. Elevated pulmonary vascular resistance and cardiac transplantation. Circulation 1987; 76(5 Pt 2): V52-V55.
15. Gajarski RJ, Towbin JA, Bricker JT, et al. Intermediate follow-up of pediatric heart transplant recipients with elevated pulmonary vascular resistance index. J Am Coll Cardiol 1994; 23: 1682-1687.
16. Rosenkranz S, Gibbs JS, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiéry JL. Left ventricular heart failure and pulmonary hypertension. Eur Heart J 2016; 37: 942-954.
17. Guazzi M, Naeije R. Pulmonary hypertension in heart failure: pathophysiology, pathobiology, and emerging clinical perspectives. J Am Coll Cardiol 2017; 69: 1718-1734.
18. Naeije R, Vanderpool R, Peacock A, Badagliacca R The right heart-pulmonary circulation unit: physiopathology. Heart Fail Clin 2018; 14: 237-245.
19. Galie N, Humbert M, Vachiery JL, et al; ESC Scientific Document Group. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016; 37: 67- 119.
20. Delgado JF, Conde E, Sanchez V, et al. Pulmonary vascular remodelling in pulmonary hypertension due to chronic heart failure. Eur J Heart Fail 2005; 7: 1011-1016.
21. Gazit AZ, Canter CE. Impact of pulmonary vascular resistances in heart transplantation for congenital heart disease. Curr Cardiol Rev 2011; 7: 59-66.
22. Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation 2012; 126: 975- 990.
23. Ortiz V, Martínez-Dolz L, Ten F, et al. Evolution of right cardiac pressures during the first year after heart transplantation. Transplant Proc 2007; 39: 2368-2371.
24. Bhat G, Costea A. Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient. ASAIO J 2003; 49: 608-610.
25. Sato T, Seguchi O, Morikawa N, et al. A heart transplant candidate with severe pulmonary hypertension and extremely high pulmonary vascular resistance. J Artif Organs 2013; 16: 253-257.
26. Sablotzki A, Hentschel T, Gruenig E, et al. Hemodynamic effects of inhaled aerosolized iloprost and inhaled nitric oxide in heart transplant candidates with elevated pulmonary vascular resistance. Eur J Cardiothorac Surg 2002; 22: 746-752.
27. Oliveira EC, Ribeiro AL, Amaral CF. Adenosine for vasoreactivity testing in pulmonary hypertension: a head-to-head comparison with inhaled nitric oxide. Respir Med 2010; 104: 606-611.
28. Kao B, Balzer DT, Huddleston CB, Canter CE. Longterm prostacyclin infusion to reduce pulmonary hypertension in a pediatric cardiac transplant candidate prior to transplantation. J Heart Lung Transplant 2001; 20: 785-788.
29. Perez-Villa F, Cuppoletti A, Rossel V, Vallejos I, Roig E. Initial experience with bosentan therapy in patients considered ineligible for heart transplantation because of severe pulmonary hypetension. Clin Transplant 2006; 20: 239-244.
30. Liden H, Haraldsson A, Ricksten SE, Kjellman U, Wiklund L. Does pretransplant left ventricular assist device therapy improve results after heart transplantation in patients with elevated pulmonary vascular resistance? Eur J Cardiothorac Surg 2009; 35: 1029-1035.
31. Chen JM, Richmond ME, Charette K, et al. A decade of pediatric mechanical circulatory support before and after cardiac transplantation. J Thorac Cardiovasc Surg 2012; 143: 344-351.
32. Yilmaz B, Zuckerman WA, Lee TM, et al. Left ventricular assist device to avoid heartlung transplant in an adolescent with dilated cardiomyopathy and severely elevated pulmonary vascular resistance. Pediatr Transplant 2013; 17: E113-E116.
33. Ofori-Amanfo G, Hsu D, Lamour JM, et al. Heart transplantation in children with markedly elevated pulmonary vascular resistance: impact of right ventricular failure on outcome. J Heart Lung Transplant 2011: 30: 659-666.
34. Klotz S, Wenzelburger F, Stypmann J, et al. Reversible pulmonary hypertension in heart transplant candidates: to transplant or not to transplant. Ann Thorac Surg 2006: 82: 1770-1773.
35. Maxwell BG, Sheikh AY, Ajuba-Iwuji CC, Heitmiller ES, Vricella LA. Pulmonary vascular resistance index and mortality after paediatric heart transplant. Cardiol Young 2015; 25: 1141-1147.
- ISSN: 0041-4301
- Yayın Aralığı: Yılda 6 Sayı
- Başlangıç: 1958
- Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
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