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Diamant MJ, Fox AL, Modi VA, Joshi AA, Clark DE, Bichell DP, Cedars A, Fowler R, Frischhertz BP, Mazurek JA, Schlendorf KH, Shah AS, Zalawadiya SK, Lindenfeld J, Menachem JN. No survival benefit associated with waiting for non-lung donor heart transplants for adult recipients with congenital heart disease. Clin Transplant 2021; 35:e14266. [PMID: 33615562 DOI: 10.1111/ctr.14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/30/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with congenital heart disease (CHD) awaiting heart transplant (HT) have higher mortality and waitlist removal due to clinical deterioration than those without CHD. The selective use of non-lung donors (NLD) to recover donor pulmonary vasculature to assist in graft implantation may be a contributing factor and is supported by consensus statements despite the recent use of pericardium or graft material as an alternative in pulmonary vascular reconstruction. The impact of selecting NLD for CHD recipients on wait time and mortality has not been evaluated. METHODS/RESULTS In the United Network for Organ Sharing (UNOS) Registry, 1271 HT recipients age ≥ 18 with CHD were identified between 1987 and 2016, 68% of which had NLDs. Prior to HT, NLD recipients were significantly less likely to be listed UNOS Status 1A, require mechanical ventilation, or intra-aortic balloon pump support. There was no difference in mean waitlist time (254 vs. 278 days, p = .31), 1-year mortality (82% vs. 80%, p = .81; adjusted odds ratio 1.32, 95% confidence interval [CI] 0.96-1.83, p = .08), or overall mortality (adjusted hazard ratio 1.08, 95% CI 0.86-1.36, p = .48) between recipients from NLD and concomitant lung donors. CONCLUSIONS Adult CHD patients who are less critically ill or listed at a lower status are more likely to receive HT from NLD. There is no overall mortality benefit associated with this practice. While specific cases may necessitate waiting for NLD, programs need to re-evaluate whether this should remain a more widespread practice among CHD patients.
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Affiliation(s)
- Michael J Diamant
- Division of Cardiology, Royal Columbian Hospital, New Westminster, BC, Canada.,Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Arieh L Fox
- Mount Sinai Heart, Mount Sinai Medical Center, St Luke's Hospital, New York, NY, USA
| | - Vivek A Modi
- St. Luke's University Health Network, Bethlehem, PA, USA
| | - Aditya A Joshi
- Mount Sinai Heart, Mount Sinai St Luke's Hospital, New York, NY, USA
| | - Daniel E Clark
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David P Bichell
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ari Cedars
- Division of Cardiology, The Johns Hopkins Hospital and Johns Hopkins Children Center, Baltimore, MD, USA
| | - Rachel Fowler
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Jeremy A Mazurek
- Advanced Heart Failure/Transplantation Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly H Schlendorf
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashish S Shah
- Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandip K Zalawadiya
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - JoAnn Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan N Menachem
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Bhattacharya PT, Troutman GS, Mao F, Fox AL, Tanna MS, Zamani P, Grandin EW, Menachem JN, Birati EY, Chirinos JA, Mazimba S, Smith KA, Kawut SM, Forfia PR, Vaidya A, Mazurek JA. Right ventricular outflow tract velocity time integral-to-pulmonary artery systolic pressure ratio: a non-invasive metric of pulmonary arterial compliance differs across the spectrum of pulmonary hypertension. Pulm Circ 2019; 9:2045894019841978. [PMID: 30880577 PMCID: PMC6540515 DOI: 10.1177/2045894019841978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pulmonary arterial compliance (PAC), invasively assessed by the ratio of stroke
volume to pulmonary arterial (PA) pulse pressure, is a sensitive marker of right
ventricular (RV)-PA coupling that differs across the spectrum of pulmonary
hypertension (PH) and is predictive of outcomes. We assessed whether the
echocardiographically derived ratio of RV outflow tract velocity time integral
to PA systolic pressure (RVOT-VTI/PASP) (a) correlates with invasive PAC, (b)
discriminates heart failure with preserved ejection-associated PH (HFpEF-PH)
from pulmonary arterial hypertension (PAH), and (c) is associated with
functional capacity. We performed a retrospective cohort study of patients with
PAH (n = 70) and HFpEF-PH (n = 86), which was further dichotomized by diastolic
pressure gradient (DPG) into isolated post-capillary PH (DPG < 7 mmHg;
Ipc-PH, n = 54), and combined post- and pre-capillary PH (DPG ≥ 7 mm Hg; Cpc-PH,
n = 32). Of the 156 patients, 146 had measurable RVOT-VTI or PASP and were
included in further analysis. RVOT-VTI/PASP correlated with invasive PAC overall
(ρ = 0.61, P < 0.001) and for the PAH (ρ = 0.38,
P = 0.002) and HFpEF-PH (ρ = 0.63,
P < 0.001) groups individually. RVOT-VTI/PASP differed
significantly across the PH spectrum (PAH: 0.13 [0.010–0.25] vs. Cpc-PH: 0.20
[0.12–0.25] vs. Ipc-PH: 0.35 [0.22–0.44]; P < 0.001),
distinguished HFpEF-PH from PAH (AUC = 0.72, 95% CI = 0.63–0.81) and Cpc-PH from
Ipc-PH (AUC = 0.78, 95% CI = 0.68–0.88), and remained independently predictive
of 6-min walk distance after multivariate analysis (standardized
β-coefficient = 27.7, 95% CI = 9.2–46.3; P = 0.004).
Echocardiographic RVOT-VTI/PASP is a novel non-invasive metric of PAC that
differs across the spectrum of PH. It distinguishes the degree of pre-capillary
disease within HFpEF-PH and is predictive of functional capacity.
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Affiliation(s)
- Priyanka T. Bhattacharya
- Center for Clinical Epidemiology and
Biostatistics, Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, USA
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory S. Troutman
- Sidney Kimmel Medical College at Thomas
Jefferson University, Philadelphia, PA, USA
| | - Frances Mao
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Arieh L. Fox
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - Monique S. Tanna
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - Payman Zamani
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - E. Wilson Grandin
- Division of Cardiology, Richard A. and
Susan F. Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan N. Menachem
- Department of Medicine, Division of
Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - Edo Y. Birati
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - Julio A. Chirinos
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
| | - Sula Mazimba
- University of Virginia Health System,
Charlottesville, VA, USA
| | - Kerri Akaya Smith
- Department of Medicine, Pulmonary
Hypertension Program, Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, USA
- Department of Medicine, Division of
Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University
of Pennsylvania, Philadelphia, PA, USA
| | - Steven M. Kawut
- Center for Clinical Epidemiology and
Biostatistics, Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, USA
- Department of Medicine, Pulmonary
Hypertension Program, Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, USA
- Department of Medicine, Division of
Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University
of Pennsylvania, Philadelphia, PA, USA
| | - Paul R. Forfia
- Pulmonary Hypertension, Right Heart
Failure and Pulmonary Thromboendarterectomy Program, Temple University Hospital,
Philadelphia, PA, USA
| | - Anjali Vaidya
- Pulmonary Hypertension, Right Heart
Failure and Pulmonary Thromboendarterectomy Program, Temple University Hospital,
Philadelphia, PA, USA
| | - Jeremy A. Mazurek
- Department of Medicine, Division of
Cardiovascular Medicine, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Pulmonary
Hypertension Program, Perelman School of Medicine at the University of Pennsylvania,
Philadelphia, PA, USA
- Jeremy A. Mazurek, Division of
Cardiovascular Medicine Hospital of the University of Pennsylvania, Perelman
Center for Advanced Medicine, South Pavilion, 11th Floor, Suite 11-179, 3400
Civic Center Boulevard, Philadelphia, PA 19104, USA.
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