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    
Abstract/OtherAbstract:
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.
Authors:
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.
Affiliation:
Cardiac Critical Care Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 1JH, United Kingdom. hoskoa@gosh.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Child
Heart Failure / diagnosis,  etiology*
Heart Transplantation* / mortality
Humans
Postoperative Complications
Pulmonary Artery / physiopathology
Retrospective Studies
Risk Factors
Vascular Resistance / physiology
Ventricular Dysfunction, Left / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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