Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients-Results from the Eurotransplant database

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part II: Cardiac Transplantation

These highlights focus on research published in the year 2022 and is divided into preoperative, intraoperative, and postoperative sections. The preoperative section includes research on the assessment and optimization of candidates for heart transplantation; donor optimization and the use of extended donors; organ protection systems; donation after circulatory death allografts; recipient factors including cannabis use, sex, race, and comorbidities such as obesity, diabetes mellitus, and peripartum cardiomyopathy; the effects of the 2018 heart allocation policy change on waitlist and postoperative mortality; updates on heart transplantation in patients with coronavirus disease 2019; in pediatric patients; and those who require a bridge to transplant. The intraoperative section includes the use of a multidisciplinary team, a proposed transfusion algorithm, bench surgery on the allograft, and size matching. The postoperative section focuses on the research on the development and management of tricuspid regurgitation, echocardiography, arrhythmia management, and, finally, xenotransplantation.

Haemodynamic phenotypes of pulmonary hypertension associated with left heart disease: a moving target

Shifting haemodynamic definitions impact prevalence of CpcPH in PH associated with left heart disease. Diastolic pressure gradient ≥7 mmHg and pulmonary vascular resistance >5 WU predict pulmonary vascular disease similarly well. https://bit.ly/3OEG5pw

Pulmonary artery pulsatility index predicts mechanical circulatory support following heart transplantation

Background

The incidence of mechanical circulatory support (MCS) for early graft dysfunction (EGD) following heart transplantation varies from 2.3% to 28.2%. Low pulmonary pulsatility index (PAPI) is associated with higher mortality in advanced heart failure and cardiogenic shock. We hypothesized that a lower pulmonary pulsatility index following heart transplantation is associated with MCS use for EGD.

Methods

Two-center study of consecutive heart transplantation from May 2018 to December 2022. Hemodynamic parameters and inotropic/vasoconstrictor data were investigated on admission to the intensive care unit (T0) and at 6 hours later (T6).

Results

Of the 173 patients included in this study, 24 had MCS for EGD. PAPI in the group that required MCS was lower at T0 (1.21 (0.84) vs 1.67 (1.23), p = 0.001) and T6 (0.77 (0.52) vs 1.44 (0.82), p = <0.001). There was no significant difference in recipient characteristics, donor characteristics (donor age and sex matching), and operative factors (warm/cold ischemic time, total ischemic time, cardiopulmonary bypass time) between the 2 groups. On multiple variable regression, PAPI at T6 was associated with delayed MCS independent of total donor organ ischemic time and short-term MCS bridge to transplantation (odds ratio, OR 0.1 (0.036-0.276), p = <0.001). Receiver operating characteristic (ROC) analysis showed an area under the ROC curve of 0.694 for T0 PAPI and 0.832 for T6 PAPI; a cut-off T6 PAPI of 1.22 had sensitivity and specificity of 81% and 65%, respectively.

Conclusions

Lower PAPI at T6 (<1.22) is independently associated with MCS use for severe EGD postheart transplantation.