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Pulmonary vascular resistance index and mortality after paediatric heart transplant

Published online by Cambridge University Press:  23 September 2014

Bryan G. Maxwell ,
Ahmad Y. Sheikh ,
Chinwe C. Ajuba-Iwuji ,
Eugenie S. Heitmiller  and
Luca A. Vricella
Bryan G. Maxwell*
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Ahmad Y. Sheikh
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CaliforniaUnited States of America
Chinwe C. Ajuba-Iwuji
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Eugenie S. Heitmiller
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America
Luca A. Vricella
Affiliation:
Department of Cardiothoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
*
Correspondence to: B. G. Maxwell, MD, MPH, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 6208P, Baltimore, MD 21287, United States of America. Tel: +410 955 9147; Fax: +410 955 0994; E-mail; bmaxwell@jhu.edu
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Abstract

Background: Although some prior studies have provided evidence to question the historical belief that pulmonary vascular resistance index ⩾6 Wood Units×m2 should be a contraindication to heart transplantation in children, no national analyses specific to the modern area have addressed this question. Methods: Data were analysed for paediatric heart transplant recipients from 1 January, 2002 to 1 September, 2012 (n=699). The relationship between pulmonary vascular resistance and all-cause 30-day mortality was evaluated using univariate and multivariate analyses. Results: The 30-day mortality included 10 patients (1.43%), which is lower than in the previous analyses. Receiver operating curve analysis of pulmonary vascular resistance index as a predictor of mortality yielded a cut-off value of 3.37 Wood Units×m2, but the area under the curve and specificity of this threshold was weaker than in previous analyses. Whereas pulmonary vascular resistance index treated as a dichotomised variable was a significant predictor of mortality in univariate (odds ratio 4.92, 95% confidence interval 1.04–23.33, p=0.045) and multivariate (odds ratio 5.26, 95% confidence interval 1.07–25.80, p=0.041) analyses, pulmonary vascular resistance index treated as a continuous variable was not a significant predictor of mortality in univariate (p=0.12) or multivariate (p=0.11) analyses. Conclusions: The relationship between pulmonary vascular resistance and post-heart transplant mortality in children is less convincing in this analysis of a comprehensive, contemporary database than in previous series. This suggests the possibility that modern improvements in the management of post-transplant right ventricular dysfunction have mitigated the contribution of pulmonary hypertension to early mortality.

Keywords

Heart transplantationpulmonary hypertensionpulmonary vascular resistancepaediatric heart transplantation
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015 , pp. 1141 - 1147
Copyright
© Cambridge University Press 2014 

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