| What is high risk? Redefining elevated pulmonary vascular resistance index in pediatric heart transplantation. | |
| | |
MedLine Citation:
|
PMID: 22019236 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
BACKGROUND: Currently, pulmonary vascular resistance index (PVRI) >6 WU × m(2) (indexed units) is generally considered a contraindication to isolated orthotopic heart transplantation (OHT). However, this has been questioned in the literature. METHODS: A retrospective review was performed on all patients <18 years old who underwent primary OHT for cardiomyopathy. Data were collected with regard to demographics, pre-operative hemodynamics, need for pre-operative mechanical circulatory support, vasodilator reactivity and 30-day mortality (30dM). A receiver operating characteristic (ROC) curve was used to establish an optimal threshold. Uni- and multivariate logistic regressions were performed to assess the influence of PVRI on 30dM. RESULTS: Complete data were available for 158 cardiomyopathy patients <18 years of age, who underwent primary OHT between June 1984 and November 2010. The ROC curve yielded a threshold of 9.290 indexed units. Four of 19 patients (21.1%) with PVRI >9 died in the first 30 days. In patients with PVRI <9, there was only 1 death among 139 patients (0.7%). Odds of mortality increased incrementally with PVRI as a continuous variable, with an odds ratio (OR) of 1.35 per indexed unit (95% confidence interval 1.12 to 1.63). PVRI was dichomotomized (PVRId) using the previously established threshold and revealed an increasing risk of mortality, OR 36.80 (95% confidence interval 3.86 to 350.90), with a PVRI of >9 indexed units. CONCLUSIONS: Using a PVRI >6 as a contraindication to isolated OHT may be too restrictive. Patients with PVRI ≤9 do not appear to be at increased risk of early mortality. In patients with PVRI >9, 30-day survival was 78.9% in this study. This represents a viable alternative to heart-lung transplantation. |
| | |
Authors:
|
Peter Chiu; Mark J Russo; Ryan R Davies; Linda J Addonizio; Marc E Richmond; Jonathan M Chen |
Related Documents
:
|
21968026 - A prospective study of percutaneous vertebroplasty in patients with myeloma and spinal ... 21609796 - Reinterventions during midterm follow-up after endovascular treatment of thoracic aorti... 21715446 - Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in ... 8583066 - Matched hemiresection interposition arthroplasty of the distal radioulnar joint. 11641586 - Long-term follow-up of patients after intraarterial thrombolytic therapy of acute verte... 9102436 - The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the nottingham experience. |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-10-21 |
Journal Detail:
|
Title: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Volume: - ISSN: 1557-3117 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
|
Created Date: 2011-10-24 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9102703 Medline TA: J Heart Lung Transplant Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Department of Surgery, Columbia University, College of Physicians & Surgeons, New York, New York. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Inter-Rater Agreement of the Goutallier, Patte, and Warner Classification Scores Using Preoperative ...
Next Document: Permanent Breast Seed Implant Dosimetry Quality Assurance.