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[Hemodynamic assessment after heart transplantation]
L Ferreira1, R M Soares, M de Oliveira
1Hospital de Santa Marta, Serviços de Cardiologia e de Cirurgia Cardio-Torácica.
Insights
Orthotopic heart transplantation patients initially experience hemodynamic disturbances, but these significantly improve by the first year post-transplant. By year two, hemodynamic evaluations in heart transplant recipients are typically normal.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Hemodynamics
Context:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Post-transplant hemodynamic status is crucial for patient outcomes.
- Long-term monitoring of hemodynamic parameters is essential for managing heart transplant recipients.
Purpose:
- To comparatively analyze hemodynamic evaluations in orthotopic heart transplant recipients.
- To assess hemodynamic changes from the preoperative period through the first and second years post-transplant.
- To identify the trajectory of hemodynamic recovery after heart transplantation.
Summary:
- Hemodynamic evaluations were performed preoperatively, at one week, and at one and two years post-orthotopic heart transplantation.
- Early post-operative period showed mild to moderate hemodynamic disturbances, including abnormal pressures and elevated vascular resistances.
- Significant improvement was observed by the first year, with normal hemodynamic parameters by the first and second years.
Impact:
- This study highlights the transient nature of early hemodynamic disturbances after heart transplantation.
- It provides evidence for the normalization of hemodynamic function in the long term.
- Findings support the importance of serial hemodynamic monitoring in heart transplant recipients.
Objective:
Comparative analysis of the results of the hemodynamic evaluations performed at the preoperative period, during the first week and at the end of the first and second years, after orthotopic heart transplantation.
Design:
Retrospective study of hemodynamic evaluation of patients submitted to orthotopic cardiac transplantation from April 1987 to April 1990.
Setting:
Transplanted patients admitted at the cardiology and cardio-toracic surgery departments of the Hospital Santa Marta.
Patients:
15 patients (eleven males and four females) aged 21 to 55 years (mean = 33.3 +/- 10.5), with the preoperative diagnosis: dilated cardiomyopathy in 11, ischemic heart disease in three and hypertrophic cardiomyopathy in one patient. All the patients were on triple immunosuppressive therapy (cyclosporine A, azatioprine and prednisolone) at the time of the first week evaluation. Three of the eight patients evaluated at the end of the first year were with double immunosuppressive regimen (without steroids), seven at NYHA functional class I and one patient at class II. The three patients evaluated at the end of the second year were on triple immunosuppressive regimen and in class I.
Interventions:
We considered, preoperatively (PrOp), at the first week (1W), and at the end of the first (1Y) and second (2Y) years: mean right atrial pressure (RA), systolic pulmonary arterial pressure (PAs), mean pulmonary arterial pressure (PAm), pulmonary capillary wedge pressure (PCW), mean systemic arterial pressure (SAm), cardiac index (CI), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). At 1Y and 2y there were also considered the left ventricular end-diastolic pressure (LVEDP) and the ejection fraction (Ej).
Results:
(table; see text) The results found at 2Y were similar to those showed at 1Y. At 1Y and 2Y LVEDP and Ej were normal.
Conclusions:
A high prevalence of mild to moderate hemodynamic disturbances characterizes the early post-operative period in cardiac transplantation. Abnormal pressures on right atrium, pulmonary artery, pulmonary capillary wedge pressure, are found on a significant number of patients, and pulmonary and systemic vascular resistances are also elevated. However at the end of the first year there is a significant improvement compared with the first week. Normality is the hallmark of hemodynamic evaluation performed in transplant recipients at the end of the first and second years.