Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-27T10:29:55.119Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary vascular resistance index and mortality after paediatric heart transplant

Published online by Cambridge University Press:  23 September 2014

Bryan G. Maxwell ,
Ahmad Y. Sheikh ,
Chinwe C. Ajuba-Iwuji ,
Eugenie S. Heitmiller  and
Luca A. Vricella
Bryan G. Maxwell*
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Ahmad Y. Sheikh
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CaliforniaUnited States of America
Chinwe C. Ajuba-Iwuji
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Eugenie S. Heitmiller
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Luca A. Vricella
Affiliation:
Department of Cardiothoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
*
Correspondence to: B. G. Maxwell, MD, MPH, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 6208P, Baltimore, MD 21287, United States of America. Tel: +410 955 9147; Fax: +410 955 0994; E-mail; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Although some prior studies have provided evidence to question the historical belief that pulmonary vascular resistance index ⩾6 Wood Units×m2 should be a contraindication to heart transplantation in children, no national analyses specific to the modern area have addressed this question. Methods: Data were analysed for paediatric heart transplant recipients from 1 January, 2002 to 1 September, 2012 (n=699). The relationship between pulmonary vascular resistance and all-cause 30-day mortality was evaluated using univariate and multivariate analyses. Results: The 30-day mortality included 10 patients (1.43%), which is lower than in the previous analyses. Receiver operating curve analysis of pulmonary vascular resistance index as a predictor of mortality yielded a cut-off value of 3.37 Wood Units×m2, but the area under the curve and specificity of this threshold was weaker than in previous analyses. Whereas pulmonary vascular resistance index treated as a dichotomised variable was a significant predictor of mortality in univariate (odds ratio 4.92, 95% confidence interval 1.04–23.33, p=0.045) and multivariate (odds ratio 5.26, 95% confidence interval 1.07–25.80, p=0.041) analyses, pulmonary vascular resistance index treated as a continuous variable was not a significant predictor of mortality in univariate (p=0.12) or multivariate (p=0.11) analyses. Conclusions: The relationship between pulmonary vascular resistance and post-heart transplant mortality in children is less convincing in this analysis of a comprehensive, contemporary database than in previous series. This suggests the possibility that modern improvements in the management of post-transplant right ventricular dysfunction have mitigated the contribution of pulmonary hypertension to early mortality.

Keywords

Heart transplantationpulmonary hypertensionpulmonary vascular resistancepaediatric heart transplantation
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015 , pp. 1141 - 1147
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Fricker, FJ, Addonizio, L, Bernstein, D, et al. Heart transplantation in children: indications. Report of the Ad Hoc Subcommittee of the Pediatric Committee of the American Society of Transplantation. Pediatr Transplant 1999; 3: 333–342.Google Scholar
2. Huang, J, Trinkaus, K, Huddleston, CB, Mendeloff, EN, Spray, TL, Canter, CE. Risk factors for primary graft failure after pediatric cardiac transplantation: importance of recipient and donor characteristics. J Heart Lung Transplant 2004; 23: 716–722.Google Scholar
3. Mehra, MR, Kobashigawa, J, Starling, R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates – 2006. J Heart Lung Transplant 2006; 25: 1024–1042.Google Scholar
4. Gazit, AZ, Canter, CE. Impact of pulmonary vascular resistances in heart transplantation for congenital heart disease. Curr Cardiol Rev 2011; 7: 59–66.CrossRefGoogle ScholarPubMed
5. Chiu, P, Russo, MJ, Davies, RR, Addonizio, LJ, Richmond, ME, Chen, JM. What is high risk? redefining elevated pulmonary vascular resistance index in pediatric heart transplantation. J Heart Lung Transplant 2012; 31: 61–66.Google Scholar
6. Brancaccio, G, Filippelli, S, Michielon, G, et al. Ventricular assist devices as a bridge to heart transplantation or as destination therapy in pediatric patients. Transplant Proc 2012; 44: 2007–2012.CrossRefGoogle ScholarPubMed