HEART TRANSPLANTATION IN RECIPIENTS WITH INITIAL PULMONARY HYPERTENSION: 9 YEARS OF EXPERIENCE IN ALMAZOV NATIONAL MEDICAL RESEARCH CENTRE

Aim: to estimate the impact of initial pulmonary hypertension (PHT) on early and long-term outcomes after heart transplantation (HTx). Materials and methods. Between January 2010 and December 2018 we performed 112 HTx. Recipients were separated into 2 groups according to right heart catheterization results: 1st group patients with PHT (n = 76; mean PAP >= 25 mm Hg) and 2nd( )group - without PHT (n = 36; mean PAP <25 mm Hg). Mean age of recipients in 1st( )group was 46,4 +/- 14,9 year-old, pulmonary vascular resistance (PVR) - 3,5 +/- 1,5 WU, PVR after reduction test (NO 80 ppm, Iloprost 20 mkg) - 2,8 +/- 1,0 WU, pulmonary artery systolic pressure (PASP) - 50,1 +/- 13,4 mm Hg. Mean age of recipients in 2(nd) group was 47,3 +/- 12,2 year-old, PVR - 2,1 +/- 0,8 WU, PASP - 27,4 +/- 5,3 mm Hg. Outcomes were estimated by the early-term (duration on ventilator and inotrope support, vasodilator indications, time in ICU, mortality) and long-term (TTE data) post-transplant results. Results. After HTx 8 patients (11%) from 1st group and 1 (3%) - from 2nd group due to right heart failure (RHF) were implanted ECMO. There was no impact of pre-transplant PHT on the duration of ventilator support, duration of inotropic support and time spent in ICU. Levosimendan treatment was successfully used in 29 patients from 1st( )group and in 6 - from 2nd group (chi-square test = 0,048), the same as nitric oxide - 61 (n = 54 from 1st group, chi-square test = 0,003). During 6 months after HTx the frequency of Sildenafil use between groups was comparable (chi-square test = 0,048). During early post-transplant follow-up 14 patients died, 30-day mortality was comparable between the groups (chi-square test - p = 0,12). Six months after HTx the level of PASP (34,2 +/- 7,1 vs. 33,8 +/- 4,8 mm Hg, p = 0,21) and PVR (1,8 +/- 0,6 vs. 1,5 +/- 0,4 WU, p = 0,07) did not differ between groups. Conclusion. Time in ICU of patients with PHT is complicated and has a higher risk of RHF that can require ECMO. The level of PVR more than 3,5 WU is not limiting for performing HTx. After HTx patients with initial PVR more than 3,5 WU shows comparable results with those who did not have PHT what allows consider them for including in HTx waiting list. In addition, 30-day in patient mortality and duration of ventilator support did not differ between recipients with or without PHT prior HTx. In dynamic after HTx all patients with reversible PHT prior surgery showed decreasing of PASP and PVR. In 6 months after HTx there was no difference of PASP and PVR between patients from both groups.