PURPOSE: Most patients with advanced heart failure, who are orthotopic heart transplant (OHTx) candidates, have pulmonary hypertension PH). In some cases, the values are so high they are in fact a contraindication to OHTx.PH has been shown to be at least partly reversible in most patients, and the values produced by the vasodilator make it possible to indicate the patient for OHTx. A most unfavorable course of transplantation in high-PH candidates was originally observed also in our program. This observation made us develop a system of PH reversibility testing and modified early postoperative management of these patients. Our communication is designed to show the impact of the system on the course of the early postoperative period.
METHODS: From 1/1995 through 12/2005, we performed a total of 431 OHTx procedures. Of this number, 65 patients were shown, using right-heart catheterization, a PH elevated to a degree requiring the administration of PGE 1 (study group).A total of 365 patients were not found to have a PH requiring PGE 1 administration (control group).The group of patients with PH includes 56 men and 9 women with a mean age of 52(18 to 67) years.
RESULTS: A comparison of early operative mortality and selected rameters of the post-operative period in our group of patients and controls is shown in Table 2 (2). Statistically significance differences were not found in any of the parameters to be reviewed.
CONCLUSION: Analysis of the results, as reported in this paper, has shown that, systematic PH reversibility testing and a modified postoperative approach allow indicate even patients with increased PAR levels to OHTx. No more differences were found between patients and controls in terms of the other parameters of the early postoperative period.
CLINICAL IMPLICATIONS: Systematic PH reversibility testing and a modified postoperative approach allow indicate even patients with increased PAR levels to OHTx.
DISCLOSURE: Hikmet Al-Hiti, No Financial Disclosure Information; No Product/Research Disclosure Information