Impact of mild pulmonary hypertension on mortality and pulmonary artery pressure profile after heart transplantation

Background: Pulmonary hypertension is a risk factor for early mortality aft er transplantation, but the risk threshold is debated. Also, little is know n about the evolution of pulmonary circulation after transplantation. The a im of this study was to determine the influence of current risk pulmonary p ressure parameters on early postoperative mortality and to assess the time- related changes in pulmonary pressure after surgery. Methods: One hundred twelve consecutive transplanted patients were studied retrospectively to determine the influence of trans-pulmonary gradient of > 12 mm Hg and pulmonary vascular resistance of >2.5 Wood units, at baseline or after vasodilator test, on early mortality. A multivariate analysis was used to study the hemodynamic parameters associated with early mortality. The pulmonary pressures of all surviving patients were studied for up to 3 years after surgery. Results: Early mortality in the groups with and without pulmonary hypertens ion were 24.4% and 5.6%, respectively (p =.009). The only variable that was independently associated with early mortality was the pulmonary vascular r esistance index (odds ratio = 1.459). Mild pulmonary hypertension disappear ed 1 year after heart transplantation. Conclusions: Mild pulmonary hypertension is a risk factor for early postope rative mortality. The hemodynamic parameter most closely associated with ea rly mortality is pulmonary vascular resistance index. The hemodynamic profi le of pulmonary circulation after heart transplantation is partially depend ent on the level of pulmonary hypertension before transplantation, at least during the first year after surgery.