High and low pulmonary vascular resistance in heart transplant candidates - A 5-year follow-up after heart transplantation shows continuous reductionin resistance and no difference in complication rate

Background In heart transplantation candidates, high pulmonary vascular res istance has been found to decrease promptly after heart transplantation wit hout any further reduction during follow-up. Pulmonary hypertension has bee n described as associated with an increased peri- and postoperative complic ation rate and mortality. This study describes the evolution of pulmonary v ascular resistance and the outcome for patients during 5 years following he art transplantation. Methods and Results Haemodynamic data, complication rate and mortality have been analysed during 5-year follow-up in all patients (n=80) who were hear t transplanted at Sahlgrenska University Hospital from 1988 through 1990, W e found a significant and continuous reduction in pulmonary vascular resist ance both in patients with a pre-operative high (>3 Wood Units; n=36), but reversible on nitroprusside. and pre-operative low (less than or equal to 3 Wood Units; n=44) pulmonary vascular resistance. A multivariate analysis s howed that a pre-operative high mean pulmonary artery and low mean pulmonar y capillary wedge pressure predicted the decline in pulmonary vascular resi stance during 5 years after heart transplantation. The need for a postopera tive assist device, complication rate, and early and late mortality were in dependent of the pre-operative level of pulmonary vascular resistance. Conclusions A continuous reduction in pulmonary vascular resistance during 5 years following heart transplantation was found in patients with both hig h, but reversible? and low pre-operative resistance levels. The outcome and survival were independent of the pre-operative pulmonary vascular resistan ce level.