Postoperative left ventricular function in different types of pulmonary hypertension: a comparative study

Area of Science:

• Cardiology
• Pulmonary Hypertension
• Transplant Surgery

Background:

• Left ventricular dysfunction is a known complication after pulmonary endarterectomy.
• Left ventricular failure is a rare but serious complication following lung transplantation for pulmonary arterial hypertension (PAH).

Purpose of the Study:

• To identify factors contributing to left ventricular failure after lung transplantation for PAH.
• To investigate whether pre-transplant atrial septostomy can prevent post-transplant left ventricular failure.

Main Methods:

• Retrospective analysis of bilateral lung transplants for PAH (n=24) and pulmonary endarterectomies (n=27).
• Analysis of perioperative demographic and echocardiographic data.
• Comparison of patients who developed left ventricular failure with other PAH patients.

Main Results:

• PAH patients were diagnosed younger and had longer time between diagnosis and surgery.
• Pre-transplant atrial septostomy increased left ventricular dimensions, stroke volume, and cardiac index.
• Two patients developed post-transplant left ventricular failure; they were younger at diagnosis, had longer pre-surgical intervals, smaller left ventricular mass, and higher pre-transplant pulmonary vascular resistance.

Conclusions:

• Younger age at diagnosis and prolonged left ventricular preload deprivation in PAH may contribute to post-transplant left ventricular failure.
• Pre-transplant atrial septostomy may be a protective measure against post-transplant left ventricular failure in PAH patients.