Incidence of Right Ventricular Dysfunction in Adult Patients Submitted to Heart Transplantation According to the Presence of Pre-Transplant Pulmonary Hypertension

Purpose: Introduction Pre-transplant irreversible pulmonary hypertension (PH) is a contraindication to heart transplantation (HTx) due to the high risk of post-transplant right ventricular (RV) dysfunction. When ventricular assist devices (VAD) are not available, HTx may be considered in selected patients PH. Objective To evaluate the incidence of right ventricular dysfunction in patients with reversible PH compared to patients with no PH submitted to HT. Methods We performed a retrospective analysis of all HTx performed from Jan-13 to Oct-17 at Heart Institute using RedCap database. PH was defined according to the presence of at least one of the following criteria at baseline: pulmonary systolic artery pressure (PSAP) > 50mmHg or pulmonary vascular resistance (PVR) >5uW or transpulmonary gradient (TPG) >15. Patients with PVR below 5uW at baseline or after the reversibility test were submitted to HTx. Early RV and LV dysfunctions and 30-day mortality were evaluated in patients with and without PH. Diastolic pulmonary gradient (DPG) was also evaluated in this cohort. Results 200 patients were submitted to HTx, 126(63%) were male, 127(63.5%) self-declared white, and with average age of 46.3±12.2 years-old. Of these patients, 180 had underwent to pre-transplant right heart catheterization. Considering criteria described above, 87(48.3%) patients had PH and were compared to patients with no PH (n=93,51.7%). Moderate/severe RV dysfunction was present in 16(18.8%) patients in PH group and 10(11.1%) patients in no HP group (p=0.152). There was also no difference in LV dysfunction (p=0.621) or 30-day mortality (p=0.534) between groups. All RV catheterization measures were higher in PH group (p Conclusion In our cohort, the incidence of RV as well as LV dysfunction and 30-day mortality were similar in patients with and without PH. In a population where VAD is not available, HTx could be an alternative to patients with PH, especially if DPG is low. Larger prospective studies should be performed to test the role of DPG in patient evaluation to HTx.