1
|
Lentine KL, Levine DJ, Runo JR, Caliskan Y, Costa S, Lam NN, Axelrod DA, Woodside KJ. Complexities and outcomes of pulmonary hypertension in kidney transplant patients: a comprehensive review. TURKISH JOURNAL OF NEPHROLOGY 2024; 33:8-26. [PMID: 38213512 PMCID: PMC10783548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Pulmonary hypertension (PH) is often present in patients presenting for kidney transplant listing. While PH can complicate kidney transplant (KTx), with multidisciplinary management that includes both the transplant center and pulmonary hypertension center or experts both pre- and post-transplant. This review summaries the approach and management of PH in KTx candidates and recipients, along with expected outcomes and controversies surrounding arteriovenous fistula and graft management.
Collapse
|
2
|
Ahmed MS, Ghallab M, Ostrow T, Nashawi M, Alagha Z, Levine A, Aronow WS, Lanier GM. Pharmacotherapy of refractory pulmonary arterial hypertension. Expert Opin Pharmacother 2023; 24:1861-1874. [PMID: 37698041 DOI: 10.1080/14656566.2023.2257134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Treatment of refractory pulmonary arterial hypertension (PAH) is challenging and rarely the focus of reviews. The purpose of this review is to discuss current treatment options of refractory PAH, along with the state of research of several new medications. AREAS COVERED We conducted a comprehensive PubMed search on the relevant literature on treating PAH, with a focus on approved and investigational interventions for high-risk patients. Our strategy used keywords 'Treatment' AND 'Pulmonary Hypertension,' without date restrictions, ensuring a thorough survey of available literature for our review. EXPERT OPINION By utilizing serial risk assessment to identify patients remaining intermediate or high-risk, more patients are likely to survive longer. This is done by earlier use of combination or triple therapy with prostacyclin drugs. Current medications for PAH are all essentially vasodilators that improve physiology, but do not truly modify the disease process. The potential application of new investigational medications is exciting as they work by novel pathways likely to change the landscape of refractory PAH treatment.
Collapse
Affiliation(s)
- Mahmoud Samy Ahmed
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Muhammad Ghallab
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Talia Ostrow
- Department of Medicine, New York Medical College, Valhalla, New York, USA
| | - Mouhamed Nashawi
- Department of Medicine, Baylor Scott & White Health, Dallas, TX, USA
| | - Zakaria Alagha
- Department of Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| |
Collapse
|
3
|
Doi A, Gajera J, Niewodowski D, Gangahanumaiah S, Whitford H, Snell G, Kaye D, Joseph T, McGiffin D. Surgical management of giant pulmonary artery aneurysms in patients with severe pulmonary arterial hypertension. J Card Surg 2022; 37:1019-1025. [PMID: 35040512 DOI: 10.1111/jocs.16235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Giant aneurysm of the pulmonary artery (PAA) is an extremely rare condition that may develop in patients with pulmonary arterial hypertension (PAH) which may be complicated by rupture, dissection or intravascular thrombus formation. The aim of this study was to examine available literature with regard to surgical strategies in patients undergoing transplantation for PAH with PAA. RESULTS These patients were traditionally considered for heart-lung transplantation but more recently, there have been reports of successful lung transplantation with reconstruction of the pulmonary artery. CONCLUSIONS Unless there is a mandatory indication for heart-lung transplantation, patients with PAH and PAA can undergo lung transplantation and reconstruction of the pulmonary artery without compromising the outcome.
Collapse
Affiliation(s)
- Atsuo Doi
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | - Jay Gajera
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| | | | | | - Helen Whitford
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Greg Snell
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Tim Joseph
- Department of Radiology, Alfred Health, Melbourne, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Australia
| |
Collapse
|
4
|
Yamamoto H, Sugimoto S, Imanishi K, Hashimoto K, Miyoshi K, Otani S, Yamane M, Toyooka S. Meticulous closure of collateral vessels in the perihilar mediastinal pleura to control intraoperative bleeding during lung transplantation for pulmonary hypertension. J Thorac Dis 2021; 13:5658-5669. [PMID: 34795916 PMCID: PMC8575835 DOI: 10.21037/jtd-21-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
Abstract
Background Massive blood transfusion compensating hemorrhage during lung transplantation (LT) results in primary graft dysfunction (PGD) and worse outcomes after LT. Collateral vessels in the perihilar mediastinal pleura could be the source of hemorrhage during LT in patients with pulmonary hypertension (PH). The purpose of this study was to examine the effect of closure with hemoclips of the vessels in the perihilar mediastinal pleura on the risk of intraoperative hemorrhage and outcomes after LT in patients with PH. Methods We retrospectively reviewed 80 patients who underwent LT, including 13 patients with primary PH, 29 patients with secondary PH, and 38 patients with non-PH. Results The median number of hemoclips was significantly higher in the primary PH group than in the non-PH group (P=0.0045) or secondary PH group (P=0.0060). The intraoperative blood loss, transfusion volume, maximum PGD grade, and the 30-day and 90-day mortality rates in the primary PH group were equivalent to those in the other two groups. Conclusions Meticulous closure of collateral vessels in the perihilar mediastinal pleura during LT in patients with primary PH allowed intraoperative hemorrhage to be controlled and might be associated with acceptable mortality rate in these patients similar to that of LT in patients with other diseases.
Collapse
Affiliation(s)
- Haruchika Yamamoto
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kentaro Imanishi
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kohei Hashimoto
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shinji Otani
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
5
|
Huston JH, Brittain EL, Robbins IM. Pulmonary Hypertension and Right Ventricular Failure: Lung Transplant Versus Heart-Lung Transplant. Cardiol Clin 2020; 38:269-281. [PMID: 32284103 DOI: 10.1016/j.ccl.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pulmonary arterial hypertension is a highly morbid disease with limited treatment options that improve survival and currently the only curative treatment is transplantation. There is a small body of literature comparing the efficacy of lung and heart-lung transplantation in this population. The bulk of evidence suggests that most patients with severe right ventricular failure undergoing transplant will have recovery of right ventricular function after lung transplantation. Existing data suggest that, in the absence of complex congenital heart disease or significant left ventricular dysfunction, double-lung transplant is the surgical procedure of choice.
Collapse
Affiliation(s)
- Jessica H Huston
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 5037, Nashville, TN 37232, USA.
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 300A, Nashville, TN 37203, USA
| | - Ivan M Robbins
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 MCN, Nashville, TN, USA
| |
Collapse
|
6
|
Pi H, Kosanovich CM, Handen A, Tao M, Visina J, Vanspeybroeck G, Simon MA, Risbano MG, Desai A, Mathier MA, Rivera-Lebron BN, Nguyen Q, Kliner J, Nouraie M, Chan SY. Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center. Chest 2020; 158:330-340. [PMID: 32109446 DOI: 10.1016/j.chest.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/22/2019] [Accepted: 01/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial pressures and is managed by vasodilator therapies. Current guidelines encourage PAH management in specialty care centers (SCCs), but evidence is sparse regarding improvement in clinical outcomes and correlation to vasodilator use with referral. RESEARCH QUESTION Is PAH management at SCCs associated with improved clinical outcomes? STUDY DESIGNAND METHODS A single-center, retrospective study was performed at the University of Pittsburgh Medical Center (UPMC; overseeing 40 hospitals). Patients with PAH were identified between 2008 and 2018 and classified into an SCC or non-SCC cohort. Cox proportional hazard modeling was done to compare for all-cause mortality, as was negative binomial regression modeling for hospitalizations. Vasodilator therapy was included to adjust outcomes. RESULTS Of 580 patients with PAH at UPMC, 455 (78%) were treated at the SCC, comprising a younger (58.8 vs 64.8 years; P < .001) and more often female (68.4% vs 51.2%; P < .001) population with more comorbidities without differences in race or income. SCC patients demonstrated improved survival (hazard ratio, 0.68; P = .012) and fewer hospitalizations (incidence ratio, 0.54; P < .001), and provided more frequent disease monitoring. Early patient referral to SCC (< 6 months from time of diagnosis) was associated with improved outcomes compared with non-SCC patients. SCC patients were more frequently prescribed vasodilators (P < .001) and carried more diagnostic PAH coding (P < .001). Vasodilators were associated with improved outcomes irrespective of location but without statistical significance when comparing between locations (P > .05). INTERPRETATION The UPMC SCC demonstrated improved outcomes in mortality and hospitalizations. The SCC benefit was multifactorial, with more frequent vasodilator therapy and disease monitoring. These findings provide robust evidence for early and regular referral of patients with PAH to SCCs.
Collapse
Affiliation(s)
- Hongyang Pi
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chad M Kosanovich
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam Handen
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA
| | - Michael Tao
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jacqueline Visina
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Marc A Simon
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael G Risbano
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Aken Desai
- Division of Cardiovascular Medicine, University of Colorado, Aurora, CO
| | - Michael A Mathier
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Belinda N Rivera-Lebron
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Quyen Nguyen
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Kliner
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Stephen Y Chan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| |
Collapse
|
7
|
Martin AK, Renew JR, Jayaraman AL, Murray AW, Fritz AV, Ramakrishna H. Analysis of Outcomes in Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1455-1466. [DOI: 10.1053/j.jvca.2018.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 01/04/2023]
|
8
|
Invasive Hemodynamic Assessment of Patients with Heart Failure and Pulmonary Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:40. [PMID: 28466117 DOI: 10.1007/s11936-017-0544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT Right heart catheterization (RHC) with a pulmonary artery (PA) catheter is a minimally invasive method of obtaining hemodynamic data (e.g., right atrial and pulmonary pressures, cardiac output, pulmonary vascular resistance), which are used to diagnose and manage patients with advanced heart failure (HF), HF with preserved ejection fraction, and pulmonary hypertension (PH). Invasive hemodynamic data obtained from RHC can aid in the prognostication of HF and PH patients and are important in guiding decisions of implanting mechanical circulatory support devices and listing patients for heart and/or lung transplantation. The basis of RHC has also paved the way for implantable hemodynamic devices to monitor pulmonary artery pressures in the outpatient setting, which can reduce rates of HF-related hospitalizations. We will discuss the utility of PA catheters in the diagnosis and management of the aforementioned disease states, the role of implantable hemodynamic monitors, and the complications associated with RHC procedures.
Collapse
|
9
|
Santos-Martínez LE, Baranda-Tovar FM, Telona-Fermán E, Barragán-García R, Calderón-Abbo MC. [Inhaled iloprost, a selective pulmonary vasodilator. Clinical evidence from its use in perioperative pulmonary hypertension cardiovascular surgery]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 85:136-44. [PMID: 25450429 DOI: 10.1016/j.acmx.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/17/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022] Open
Abstract
Inhaled iloprost is one of the most recent drugs from prostanoids group's in the treatment of pulmonary arterial hypertension. His place in pulmonary hypertension seen in the perioperative cardiovascular surgery has not been defined. In this review we analyze pulmonary hypertension group's susceptibles of cardiac surgery and its importance, besides the current clinical evidence from drug use in this context.
Collapse
Affiliation(s)
- Luis Efren Santos-Martínez
- Departamento de Hipertensión Pulmonar y Función Ventricular Derecha, Unidad Médica de Alta Especialidad (UMAE), Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México DF, México; Secretaría de Salubridad y Asistencia (SSA), Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, SSA, México DF, México.
| | - Francisco Martín Baranda-Tovar
- Secretaría de Salubridad y Asistencia (SSA), Departamento de Cuidados Intensivos Posquirúrgicos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, SSA, México DF, México
| | - Eslí Telona-Fermán
- Secretaría de Salubridad y Asistencia (SSA), Departamento de Anestesiología Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, SSA, México DF, México
| | - Rodolfo Barragán-García
- Sub-Dirección de Especialidades Médico-Quirúrgicas, Instituto Nacional de Cardiología Ignacio Chávez, SSA, México DF, México
| | - Moisés Cutiel Calderón-Abbo
- Dirección General, Unidad Médica de Alta Especialidad (UMAE), Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México DF, México
| |
Collapse
|
10
|
EXP CLIN TRANSPLANTExp Clin Transplant 2014; 12. [DOI: 10.6002/ect.2013.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
11
|
Santos-Martínez LE, Moreno-Ruiz LA, Jiménez-Santos M, Olmos-Temois SG, Bojorquez-Guerrero LA, Baranda-Tovar FM. Utilidad clínica del iloprost inhalado en la hipertensión arterial pulmonar. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:202-10. [DOI: 10.1016/j.acmx.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 11/17/2022] Open
|
12
|
Ahmed S, Palevsky HI. Pulmonary Arterial Hypertension Related to Connective Tissue Disease. Rheum Dis Clin North Am 2014; 40:103-24. [DOI: 10.1016/j.rdc.2013.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
13
|
Thunberg CA, Gaitan BD, Grewal A, Ramakrishna H, Stansbury LG, Grigore AM. Pulmonary Hypertension in Patients Undergoing Cardiac Surgery: Pathophysiology, Perioperative Management, and Outcomes. J Cardiothorac Vasc Anesth 2013; 27:551-72. [DOI: 10.1053/j.jvca.2012.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Indexed: 11/11/2022]
|