COMPARATIVE OUTCOME OF HEART-LUNG AND LUNG TRANSPLANTATION FOR PULMONARY-HYPERTENSION

Despite the development of several lung transplantation procedures, th e most advantageous for pulmonary hypertension remains controversial. Between 1986 and February 1992, 30 patients with end-stage primary pul monary hypertension (n = 24), chronic pulmonary embolism (n = 4), and hystiocytosis X (n = 2) underwent heart-lung (n = 21), double lung (n = 8), or single lung (n = 1) transplantation. Indications for double l ung transplantation were similar to those for heart-lung transplantati on, and the preoperative clinical and hemodynamic parameters were not significantly different between the two groups. There were no intraope rative deaths, but two reoperations were needed for pleural hematoma. Five early deaths were related to graft failure (two heart-lung transp lantations), mediastinitis (one heart-lung tranplantation), multiorgan failure (one double lung transplantation), and aspergillosis (one dou ble lung transplantation). There was a similar improvement in early (d ays 0 and 2) and late (6 months postoperatively) right-sided hemodynam ic function in patients undergoing heart-lung and double lung transpla ntation. Three double lung transplant recipients had early and reversi ble left ventricular-failure. The early postoperative course of the on e patient who had single lung transplantation was characterized by sev ere pulmonary edema, left ventricular failure, and persistent desatura tion and later on by moderate pulmonary hypertension and an important ventilation/perfusion mismatch. The pulmonary function results were al so similar in the heart-lung and double lung transplantation groups. T he overall projected 2- and 4-year survivals were 49% and 41%, respect ively, and were not significantly different between the heart-lung and double lung recipients. Results demonstrate that heart-lung and doubl e lung transplantation are equally effective in obtaining early and du rable right-sided hemodynamic and respiratory improvement and similar respiratory function. In patients with pulmonary hypertension, double lung transplantation should be preferred to single lung transplantatio n because of the critical postoperative course and the uncertain long- term results of single lung transplantation.