The Effect Of Pre-operative Pulmonary Hypertension On Outcomes Of Heart Transplantation

Objective Patients with end-stage heart disease who need undergoing heart transplantation always accompany with different degrees of elevated pulmonary artery pressure, this article aims to explore the effect of pre-operative pulmonary hypertension on outcomes of heart transplantation by analyzing the patients who had underwent heart transplantation retrospectively.Methods 41 end-stage heart disease patients who had underwent heart transplantation were selected and their clinical data of peri-operative period was also collected by reviewing the medical clinical records. Among the 41 patients,30 (73.2%) were male, and 11 (26.8%) were female, ASA classification ranged from Ⅳ to Ⅴ, NYHA classification ranged from Ⅲ to Ⅳ. The age of subjects ranged from 16 to 68 years, with an average of 46.0±13.0 years, the weight ranged from 46 to 86 kg, with an average of 64.6±15.2 kg. All 41 patients had end-stage heart disease, including 30 patients with dilated cardiomyopathy (73.2%),4 with hypertrophic cardiomyopathy(9.8%),3 with ischemic cardiomyopathy(7.3%),1 with restrictive cardiomyopathy (2.4%),2 with coronary heart disease (4.8%), and 1 with congenital heart disease(2.4%). According to the monitor records of Swan-Ganz catheters,41 patients were divided into two groups by different mean pulmonary arterial pressure (mPAP), group of pulmonary hypertension (mPAP> 25mmHg, n=20) and group of control (mPAP ≤ 25mmHg, n=21). Then analyzed the effect of pre-operative pulmonary hypertension on post-operative acute kidney injury (AKI), pulmonary infection, assisted breathing time of ventilator, duration of CCU stays, hospital stays and the rate of survival retrospectively.Results All 41 patients were performed with allogeneic orthotopic heart transplantation,1 was standard orthotopic heart transplantation and the rest were double cavity vein anastomosis method of orthotopic heart transplantation.3 patients died during hospitalization after transplantation, the rest of 38 patients discharged successfully, the reasons of causing death included upper gastrointestinal hemorrhage, pulmonary embolism and multiple organ failure. The patients were followed up for 2-132 months, the 1-year,3-year, and 5-year survival rates were 90.2%、81.5%、and 70.6%, respectively. There were 18 patients(43.9%)suffered from AKI after operation, 12 patients in group of pulmonary hypertension and 6 patients in group of control (x2=4.108, P=0.043). Besides,14 patients (34.1%) suffered from pulmonary infection,8 patients in group of pulmonary hypertension and 6 patients in group of control(x2=0.595, P=0.440). The post-operative assisted breathing time of ventilator (36.6±10.5 h vs 24.6±9.8 h), duration of CCU stays (6.4±1.4 d vs 4.6±1.2 d) and hospital stays(37.7±11.2 d vs 27.6±10.0 d) were significantly different between the groups, P<0.05. The survival analysis of Log-Rank test between the groups showed a significantly different post-operative survival rate,χ2=4.660,P=0.031. As we can see from the survival curve of Kapla-Meier,the survival rate of 3 years was the most significantly different,1-year,3-year, and 5-year survival rates of the pulmonary hypertension group and the control group were 78.6% vs 95.2% 72.1% vs 90.1% and 72.1% vs 69.5%, respectively.Conclusion Pulmonary hypertension has obvious effect on heart transplantation outcome. It not only increases the risk of post-operative acute kidney injury but also decreases the survival rate of 3 years, it is not conducive to recovery of the patients anyway.