Right Heart Recovery Post Lung Transplant With COVID-19-Related Acute Respiratory Distress Syndrome

Area of Science:

• Cardiology
• Pulmonology
• Transplant Surgery

Background:

• Severe COVID-19-associated acute respiratory distress syndrome (ARDS) can lead to right heart remodeling.
• Limited data exists on right heart recovery after lung transplantation in this specific patient group.

Purpose of the Study:

• To evaluate right heart remodeling and recovery following lung transplantation in patients with COVID-19-associated ARDS.
• To assess changes in right ventricular (RV) size, function, and hemodynamics pre- and post-transplant.

Main Methods:

• Retrospective review of lung transplant recipients for COVID-19 ARDS between June 2020 and June 2022.
• Analysis of demographic, laboratory, histopathologic, transplant outcomes, and pre- and postoperative echocardiographic data.
• Comparison of RV size grade, RV function, RV systolic pressure (RVSP), and RV free wall strain before and after transplantation.

Main Results:

• Thirty-six patients with COVID-19 ARDS underwent lung transplantation; 1-year survival was 88.8%.
• Postoperative echocardiography showed significant improvement in RV size (1.7 to 1.3, p < 0.05) and RV function (2.2 to 1, p < 0.05).
• Mean pulmonary artery pressure decreased, and RVSP reduced from 46.5 to 30.1 mmHg (p < 0.05); RV free wall strain improved from -13.9% to -18.5% (p < 0.05).

Conclusions:

• Lung transplantation leads to significant improvement and normalization of right ventricular size and systolic function in patients with COVID-19 ARDS.
• These positive changes occur within a relatively short postoperative period.
• The findings support lung transplantation as an effective treatment for severe COVID-19 ARDS with associated right heart dysfunction.