Pulmonary vascular remodelling after heart transplantation in patients with cavopulmonary connection

Aditya K. Kaza, Elisabeth Kaza, Emily Bullock, Sheri Reyna, Angela Yetman, Melanie D. Everitt

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES: Pulmonary vascular resistance (PVR) after heart transplantation (HT) is an important predictor of postoperative outcomes. We hypothesize that PVR and pulmonary capillary wedge pressure (PCWP) will exhibit favourable pulmonary vascular remodelling in patients with failing cavopulmonary connection (CPC) after HT. METHODS: Retrospective analysis of patients with superior CPC (SCPC) and total CPC (TCPC) who have undergone HT was performed. Patient data, including age, underlying congenital heart defect, timing of CPC surgery and timing of HT, were reviewed. Right heart catheterization data, including PCWP (mmHg) and PVR indexed (PVRi, Woods Units) from preoperative, at 1 month, 6 months and 12 months after HT, were collected. Paired data were analysed using Student's t-test. RESULTS: Among 21 patients with failing CPC who underwent HT, 10 had SCPC and 11 had TCPC. Average age at HT was 13.3 ± 8 years. Average time after CPC to HT was 8.5 ± 6.2 years. PVRi was noted to trend down over time after HT (PVRi pre-HT versus 6 months after HT, 2.75 vs 2.06, P = 0.06 and pre-HT versus 12 months after HT, 2.79 vs 2.27, P = 0.09). There was a statistically significant decrease in PCWP at 6 months (pre-HT versus 6 months after HT, 12.6 vs 10.8, P = 0.01) and 12 months (pre-HT versus 12 months after HT, 12.9 vs 10.1, P = 0.01) after HT. CONCLUSIONS: Pulmonary vascular changes occur gradually after HT in patients with CPC similar to those shown after HT in patients with cardiomyopathy. However, larger studies are needed to investigate correlation between outcomes and the presence or absence of pulmonary vascular changes after HT in CPC patients.

Original languageEnglish (US)
Article numberezu198
Pages (from-to)505-510
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Heart Transplantation
Lung
Pulmonary Wedge Pressure
Vascular Remodeling
Vascular Resistance
Blood Vessels
Congenital Heart Defects

Keywords

  • Fontan circulation
  • Heart transplantation
  • Single ventricle

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pulmonary vascular remodelling after heart transplantation in patients with cavopulmonary connection. / Kaza, Aditya K.; Kaza, Elisabeth; Bullock, Emily; Reyna, Sheri; Yetman, Angela; Everitt, Melanie D.

In: European Journal of Cardio-thoracic Surgery, Vol. 47, No. 3, ezu198, 01.03.2015, p. 505-510.

Research output: Contribution to journalArticle

Kaza, Aditya K. ; Kaza, Elisabeth ; Bullock, Emily ; Reyna, Sheri ; Yetman, Angela ; Everitt, Melanie D. / Pulmonary vascular remodelling after heart transplantation in patients with cavopulmonary connection. In: European Journal of Cardio-thoracic Surgery. 2015 ; Vol. 47, No. 3. pp. 505-510.
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AU - Everitt, Melanie D.

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AB - OBJECTIVES: Pulmonary vascular resistance (PVR) after heart transplantation (HT) is an important predictor of postoperative outcomes. We hypothesize that PVR and pulmonary capillary wedge pressure (PCWP) will exhibit favourable pulmonary vascular remodelling in patients with failing cavopulmonary connection (CPC) after HT. METHODS: Retrospective analysis of patients with superior CPC (SCPC) and total CPC (TCPC) who have undergone HT was performed. Patient data, including age, underlying congenital heart defect, timing of CPC surgery and timing of HT, were reviewed. Right heart catheterization data, including PCWP (mmHg) and PVR indexed (PVRi, Woods Units) from preoperative, at 1 month, 6 months and 12 months after HT, were collected. Paired data were analysed using Student's t-test. RESULTS: Among 21 patients with failing CPC who underwent HT, 10 had SCPC and 11 had TCPC. Average age at HT was 13.3 ± 8 years. Average time after CPC to HT was 8.5 ± 6.2 years. PVRi was noted to trend down over time after HT (PVRi pre-HT versus 6 months after HT, 2.75 vs 2.06, P = 0.06 and pre-HT versus 12 months after HT, 2.79 vs 2.27, P = 0.09). There was a statistically significant decrease in PCWP at 6 months (pre-HT versus 6 months after HT, 12.6 vs 10.8, P = 0.01) and 12 months (pre-HT versus 12 months after HT, 12.9 vs 10.1, P = 0.01) after HT. CONCLUSIONS: Pulmonary vascular changes occur gradually after HT in patients with CPC similar to those shown after HT in patients with cardiomyopathy. However, larger studies are needed to investigate correlation between outcomes and the presence or absence of pulmonary vascular changes after HT in CPC patients.

KW - Fontan circulation

KW - Heart transplantation

KW - Single ventricle

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