Impact of Preoperative Pulmonary Vascular Resistance on Outcomes after Heart Transplantation

Background: In patients scheduled for heart transplantation (HTX) assessment and potential optimization of pulmonary vascular resistance (PVR) is crucial for a successful postoperative outcome. Elevated resistance in the pulmonary circulation can impose additional burden on the transplanted organ, potentially compromising right ventricular function. This analysis examines the impact of recipients’ preoperative pulmonary vascular resistance (PVR) on outcomes following heart transplantations at a single center.

Methods: Between 2010 and 2024, n = 336 donor hearts were transplanted at our center. Demographic and health-specific data of the patients were collected in a database and retrospectively analyzed. Patients listed for transplantation underwent right heart catheterization as part of their preoperative diagnostics. Based on preoperative PVR values (dyn × sec × cm⁻⁵), the patient cohort was categorized into four groups (Group 1: <100; Group 2: 100–200; Group 3: 200–300; Group 4: ≥300), and outcomes were retrospectively compared. To ensure a secure organ transplantation, all patients with a critically elevated PVR underwent a preoperative reversibility test as part of the screening process.

Results: In total, 25.7% of patients were in Group 1, while 35.3% were assigned to Group 2. Group 3 consisted of 19.8% of patients, and 19.2% were included in Group 4. The average preoperative PVR was 193.7 ± 9.5 dyn × sec × cm⁻⁵. Regarding mortality, no significant difference was observed among the groups for 30 days after transplantation. However, the 5-year survival rate was notably higher in Group 1, at 82%, compared with only 45% in Group 4. Noticeable disparities in the mean length of hospital stay were noted, with Group 1 averaging 40 days and Group 4 extending to 54 days. Also, the intensive care unit stay was prolonged in patients with higher preoperative PVR. In terms of the postoperative occurrence of neurological impairments, organ rejections, and the necessity for ECLS or repeat sternotomy, no significant differences were identified between the groups.

Conclusion: Despite no significant differences in mortality within the first 30 days after heart transplantation across various PVR groups, disparities emerged over a 5-year period. Patients with higher preoperative PVR experienced extended hospital stays, suggesting the transplanted organ’s added strain due to increased PVR and emphasizing the necessity for tailored postoperative care. Preoperative pulmonary vascular resistance evaluation is crucial for optimizing postoperative cardiac function and long-term survival.

Publication History

Article published online:
11 February 2025