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Clin Transplant. 2019 May 10:e13586. doi: 10.1111/ctr.13586. [Epub ahead of print]

Lung transplantation in patients with severe pulmonary hypertension - Focus on right ventricular remodeling.

Author information

1
Department of Anaesthesiology.
2
Clinic of Cardiac Surgery.
3
Department of Thoracic Surgery.
4
Internal Medicine V, Comprehensive Pneumology Center, German Center for Lung Research.
5
Internal Medicine I.
6
Transplantation Center, Ludwig Maximilian University Munich, Marchioninistr. 15, D-81377, Munich.
7
Cardiothoracic Surgery, Heart- and Diabetes Center North Rhine Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.

Abstract

OBJECTIVE:

This study was meant to analyse the centre experience of the Munich Lung Transplant Group in lung transplantation of patients with severe pulmonary hypertension. Outcome data focus on survival and right heart remodeling.

METHODS:

All patients receiving a lung transplant between 10/2010 and 08/2016 were retrospectively analysed (n=343). Patients were categorised into individuals with or without severe preoperative pulmonary hypertension (PH; mPAP ≥35 mmHg or mPAP ≥25 mmHg with cardiac index <2.0 L·min-1 ·m-2 ). Among those, patients with severe PH secondary to lung disease (Nice Class III) were compared to patients with severe PH due to idiopathic PH (IPAH; Nice Class I). All surviving patients with severe PH were electively followed up by echocardiography.

RESULTS:

Kaplan-Meier survival probabilities after lung transplantation of each group according to preoperative mPAP values showed no statistically significant difference (P=0.14 by log-rank test). Lung transplantation in severe PH patients led to marked right ventricular remodeling as indicated by significantly increased Tricuspid Annular Plane Systolic Excursion (TAPSE) (P=0.002), decreased right ventricular end-diastolic dimensions (P=0.001) and overall reduction of tricuspid valvular regurgitation, when compared to preoperative assessments.

CONCLUSION:

Sequential bilateral lung transplantation (BLTx) in patients with severe pulmonary hypertension is a feasible treatment option in this high-risk group in experienced high-volume centres. Lung transplantation allows for resolution of secondary right heart failure in these patients. This article is protected by copyright. All rights reserved.

KEYWORDS:

Lung transplantation; extracorporeal circulation; pulmonary hypertension

PMID:
31074521
DOI:
10.1111/ctr.13586

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