Pre-existing elevated pulmonary vascular resistance: long-term hemodynamicfollow-up and outcome of recipients after orthotopic heart transplantation

Background. Elevation of pulmonary vascular resistance (PVR) has been consi dered to predict a bad outcome after orthotopic heart transplantation (HTx) . A transpulmonary gradient (TG) greater than or equal to 15 mmHg and PVR g reater than or equal to 5 wood (w) are correlated with a three-fold increas e in. 2-days as well as 30-days and 6-, 12-month mortality. Methods. We performed a retrospective analysis of 400 consecutive transplan ted patients (pts) on hemodynamic data over a time period of 3.5 years. In 83 pts (23%) preoperative PVR was greater than or equal to 5 w and TG >15 m mHg. Vasodilator studies were performed in this group of pts in order to ev aluate pulmonary vasoreactivity or hemodynamic improvement. Results. Hemodynamic follow-up post-transplantation showed a significant (p <0.001) decrease in mean TG to 8.8 mmHg within the first, 7.7 after the fif th year as well as decrease in PVR from 5.5 to 1.6, within the first and fi fth year post-transplantation. Compared to the control group (n = 286) (re- transplants n = 6 and pediatric pts n = 25 excluded) pts with TG <15 mmHg a nd/or PVR <5 w, transplanted within the same period, 30-day mortality and c umulative survival after 1 and 5 years do not show any significant differen ce with a mortality of 3%, 22% and 33% (p<0.05). Subgroup analysis for pts with endstage of ischemic versus dilatative cardiomyopathy has not shown an y significant difference in mortality. Conclusions. In a retrospective analysis of 400 pts elevated PVR does not p redict a bad outcome after orthotopic heart transplantation in early and la te mortality.