Donor–recipient predicted heart mass ratio and right ventricular–pulmonary arterial coupling in heart transplant. (30th November 2020)

• Record Type: Journal Article
• Authors: Nazario, Raffaela de Almeida; Goldraich, Livia Adams; Hastenteufel, Laura Carolina Tavares; Santos, Angela B S; Carrion, Luciana; Clausell, Nadine
• Is Part Of: European journal of cardio-thoracic surgery. Volume 59:Number 4(2021)
• Page Start: 847
• Page End: 854
• Publication Date: 2020-11-30
• Subjects: Heart transplant -- Donor–recipient mismatch -- Right ventricular–pulmonary arterial coupling; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa391
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Right ventricular–pulmonary arterial (RV–PA) coupling interactions are largely unexplored in heart transplant patients. The outcome of this study was RV–PA coupling at 7 and 30 days after heart transplant and its association with donor–recipient size matching. METHODS: Clinical, echocardiographic and haemodynamic data from a retrospective cohort of heart transplant recipients and respective donors were reviewed. Coupling between RV–PA was examined by assessing the RV fractional area change and pulmonary artery systolic pressure ratio. Donor–recipient size matching was assessed by the predicted heart mass (PHM) ratio, and groups with a PHM ratio <1 and ≥1 were compared. RESULTS: Forty-four heart transplant recipients were included in this study (50 years, 57% male sex). Postoperative RV–PA coupling improved from 7 to 30 days (RV fractional area change/pulmonary artery systolic pressure 0.9 ± 0.3 vs 1.2 ± 0.3; P < 0.001). A positive association was found between an adequate PHM ratio and improvement of RV fractional area change/pulmonary artery systolic pressure at 30 days, independent of graft ischaemic time and pre-existent pulmonary hypertension ( B coefficient 0.54; 95% confidence interval 0.11–0.97; P = 0.016; adjusted R 2 = 0.24). CONCLUSIONS: These findings highlight the role of PHM as a metric to help donor selection and suggest its impact in RV–PA coupling interactions post-heart transplant.