Document Detail

Acute right ventricular failure after pediatric cardiac transplant: predictors and long-term outcome in current era of transplantation medicine.
MedLine Citation:
PMID:  19910002     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To identify pretransplant factors associated with postprocedural right ventricular failure and the relationship between right ventricular failure and long-term survival in children. METHODS: Records were reviewed for children having heart transplantation from 2000 to 2006. RESULTS: Right ventricular failure was identified by clinical and echocardiographic parameters in 33/129 (25%) recipients: dilated cardiomyopathy in 14/90 (15%), congenital heart disease in 11/27 (41%), and restrictive cardiomyopathy in 8/12 (66%). In 9 of 12 (75%), known elevated (reactive) pulmonary vascular resistance progressed to right ventricular failure. In a further 23/117 (20%) recipients, pulmonary vascular resistance within predefined acceptable range progressed to right ventricular failure. Multiple logistic regression analyses indicated elevated pulmonary vascular resistance (odds ratio 12.30; 95% confidence interval 2.73, 55.32; P = .001) and primary diagnosis, restrictive cardiomyopathy (odds ratio 9.21; 95% confidence interval 2.07, 41.12; P = .004), and congenital heart disease (odds ratio 4.07; 95% confidence interval 1.36, 12.19; P = .012) were strongly associated with right ventricular failure, but duration of heart failure, pretransplant mechanical support, donor status, and ischemic times were not. Treatment included inhaled nitric oxide in 28 (84%), mechanical support in 10 (31%), hemofiltration in 13 (40%), and retransplantation in 2. A Cox multiple regression model including: primary diagnosis, right ventricular failure, and elevated pulmonary vascular resistance indicated that only the latter was independently linked with eventual mortality (hazards ratio 5.45; 95% confidence interval 1.36, 21.96; P = .017). CONCLUSIONS: Primary diagnosis and pretransplant elevated reactive pulmonary vascular resistance are both linked to the evolution of right ventricular failure. Pulmonary vascular resistance assessment in end-stage heart failure is challenging; therefore, avoidance of right ventricular failure may not always be possible. Aggressive early treatment may mitigate the effects of right ventricular failure: pretransplant elevated pulmonary vascular resistance was independently associated with long-term survival, but right ventricular failure was not.
Aparna Hoskote; Catherine Carter; Phillip Rees; Martin Elliott; Michael Burch; Katherine Brown
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-11-11
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  139     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-28     Completed Date:  2010-03-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  146-53     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Cardiac Critical Care Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 1JH, United Kingdom.
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MeSH Terms
Acute Disease
Heart Failure / diagnosis,  etiology*
Heart Transplantation* / mortality
Postoperative Complications
Pulmonary Artery / physiopathology
Retrospective Studies
Risk Factors
Vascular Resistance / physiology
Ventricular Dysfunction, Left / etiology*

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