The effect of preoperative pulmonary artery pressure on early postoperative right ventricular function in patients with heart transplantation

doi:10.3877/cma.j.issn.2095-655X.2021.04.002

Abstract

Abstract:

Objective

To investigate the effect of the preoperative pulmonary artery pressure on early postoperative right ventricular function in patients undergoing heart transplantation with left heart failure and receiving the heart transplantation.

Methods

A retrospective analysis was made, which was based on 79 patients who underwent the orthotopic cardiac transplantation for end-stage heart failure at the Heart Transplantation Center, the First Affiliated Hospital of Shandong First Medical University from August 2010 to February 2018. The systolic pulmonary artery pressure (PASP) was defined as the sum tricuspid regurgitation pressure difference and right atrial pressure measured by echocardiography. The patients were divided into the pulmonary hypertension group (preoperative PASP≥45 mmHg, 1 mmHg=0.133 kPa), n=45) and the control group (preoperative PASP<45 mmHg, n=34) respectively.The preoperative general data, the intraoperative cardiopulmonary bypass time, and the early postoperative right heart function were analyzed and compared between the two groups.

Results

The preoperative right ventricular outflow tract forward blood flow acceleration time (RVact) was (96.83±8.53) ms in the pulmonary hypertension group, (106.00±4.90)ms in the control group. The difference was statistically significant (t=-6.05, P<0.01). The intraoperative cardiopulmonary bypass time of pulmonary hypertension group [(266.69±71.80)min] was higher than that of the control group [(221.24±70.19)min], the difference was statistically significant (t=2.81, P<0.01). The right ventricular longitudinal strain (RVLS) [(-12.19±2.03)%, (-19.22±2.06)%] and the right ventricular fractional area change (RVFAC) [(26.88±6.15)%, (36.50±2.17)%] were analyzed by echocardiography 3 days after operation between the two groups, and the differences were statistically significant (t=15.11, -9.72, all P<0.01). In addition, the differences of RVLS [(-12.02±1.99)%, (-19.40±1.82)%], tricuspid annular plane systolic excursion (TAPSE) [(17.46±2.06)mm, (18.68±1.74)mm] and RVFAC [(29.50±6.28)%, (37.60±2.72)%] between the two groups in echocardiography 15 days after operation were also statistically significant (t=17.14, -2.85, -7.74, all P<0.01).

Conclusion

Patients with preoperative PASP≥45 mmHg are more likely to develop the severe right ventricular insufficiency in the early postoperative period after heart transplantation.

Key words: Heart transplantation, Echocardiography, Hypertension, pulmonary, Ventricular dysfunction, right

Wen Huang, Haiyan Wang, Rui Xu. The effect of preoperative pulmonary artery pressure on early postoperative right ventricular function in patients with heart transplantation[J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(04): 221-225.

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References 19

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项目		PH组(n＝45)	对照组(n＝34)	统计量	P值
年龄(岁，±s)		48.02±12.04	46.38±11.45	t＝0.62	0.540
性别(例)				χ²＝2.31	0.100
	男	37	23
	女	8	11
体重指数(kg/m²，±s)		20.43±1.92	20.61±2.12	t＝-0.41	0.732
LVEF(%，±s)		25.89±0.62	26.41±0.13	t＝-5.58	0.289
LVEDD(mm，±s)		71.78±9.54	72.29±8.12	t＝-0.26	0.798
RVact(ms，±s)		96.83±8.53	106.00±4.90	t＝-6.05	0.000
肺动脉内径(mm，±s)		25.50±2.17	25.90±1.79	t＝-0.45	0.659
PASP(mmHg，±s)		62.23±11.72	33.12±9.18	t＝4.65	0.009

项目		PH组(n＝45)	对照组(n＝34)	统计量	P值
年龄(岁，±s)		48.02±12.04	46.38±11.45	t＝0.62	0.540
性别(例)				χ²＝2.31	0.100
	男	37	23
	女	8	11
体重指数(kg/m²，±s)		20.43±1.92	20.61±2.12	t＝-0.41	0.732
LVEF(%，±s)		25.89±0.62	26.41±0.13	t＝-5.58	0.289
LVEDD(mm，±s)		71.78±9.54	72.29±8.12	t＝-0.26	0.798
RVact(ms，±s)		96.83±8.53	106.00±4.90	t＝-6.05	0.000
肺动脉内径(mm，±s)		25.50±2.17	25.90±1.79	t＝-0.45	0.659
PASP(mmHg，±s)		62.23±11.72	33.12±9.18	t＝4.65	0.009

项目	肺动脉高压组(n＝45)	对照组(n＝34)	t值	P值
供体缺血时间(min)	273.69±79.52	269.00±95.61	0.23	0.817
体外循环时间(min)	266.69±71.80	221.24±70.19	2.81	0.006
肺血管阻力(Wood)	4.54±2.43	3.06±1.82	3.17	0.003

项目	肺动脉高压组(n＝45)	对照组(n＝34)	t值	P值
供体缺血时间(min)	273.69±79.52	269.00±95.61	0.23	0.817
体外循环时间(min)	266.69±71.80	221.24±70.19	2.81	0.006
肺血管阻力(Wood)	4.54±2.43	3.06±1.82	3.17	0.003

项目	术后第3天				术后第15天
项目	PH组(n＝45)	对照组(n＝34)	t值	P值	PH组(n＝45)	对照组(n＝34)	t值	P值
RVLS(%)	-12.19±2.03	-19.22±2.06	15.11	0.000	-12.02±1.99	-19.40±1.82	17.14	0.000
TAPSE(mm)	16.10±8.05	17.53±2.87	-1.10	0.275	17.46±2.06	18.68±1.74	-2.85	0.006
RVFAC(%)	26.88±6.15	36.50±2.17	-9.72	0.000	29.50±6.28	37.60±2.72	-7.74	0.000
LVEF(%)	65.00±2.61	69.50±5.40	-4.48	0.262	65.50±2.99	66.71±4.57	-1.34	0.185
LVEDD(mm)	42.36±4.20	44.00±6.38	-1.30	0.199	42.89±3.30	42.33±2.42	0.87	0.387
PASP(mmHg)	30.40±7.68	31.20±9.13	-0.41	0.691	29.60±4.50	28.40±5.27	1.06	0.290

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