DETERMINANTS OF RIGHT-VENTRICULAR FAILURE AFTER HEART-TRANSPLANTATION

Predictive factors of right ventricular failure after heart transplant ation are not well identified. Clinical and hemodynamic data from 20 p atients who developed right heart failure were compared to those of 20 matched patients who did not experience this complication after cardi ac transplantation. Preoperative systemic and pulmonary hemodynamics w ere comparable in the two groups. Patients with posttransplant right v entricular failure had longer waiting time (27+/-6 vs 16+/-3 weeks, me an+/-SE, P <0.05), no regression of pulmonary hypertension (0+/-0.1 vs 2.3+/-0.3 Wood units reduction in pulmonary vascular resistance after transplantation, P <0.01), and had been ventilated with higher levels of positive end-expiratory pressure (5+/-1 vs 1.5+/-0.5 cm H2O, P <0. 05). One-month postoperative evolution (mortality, hospital stay, radi onuclide ejection fractions) was similar in the two groups. these resu lts suggest that a lesser reversibility of pulmonary hypertension (pos sibly due to a longer evolution of the cardiac disease, as indicated b y the longer waiting time) is the main determinant of right ventricula r failure after heart transplantation.