Right but not left ventricular function recovers early after living-donor lobar lung transplantation in patients with pulmonary arterial hypertension

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 1; pp. 222 - 226
• Main Authors: Toyooka, Shinichi, MD, Kusano, Kengo Fukushima, MD, Goto, Keiji, MD, Masaomi, Yamane, MD, Oto, Takahiro, MD, Sano, Yoshifumi, MD, Fuke, Soichiro, MD, Okazaki, Megumi, RN, Ohe, Toru, MD, Kasahara, Shingo, MD, Sano, Shunji, MD, Date, Hiroshi, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2009; AATS/WTSA; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Cardiac Output; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Humans; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - surgery; Living Donors; Lung Diseases - physiopathology; Lung Diseases - surgery; Lung Transplantation; Male; Medical sciences; Pneumology; Pulmonary Artery - physiopathology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Stroke Volume; Ventricular Function, Left; Ventricular Function, Right; 12; RVEF; CI; forced vital capacity; systolic pulmonary artery pressure; cardiac index; LVEF; left ventricular ejection fraction; FVC; LDLLT; right ventricular ejection fraction; PAH; sPAP; pulmonary artery pressure; pulmonary arterial hypertension; PAP; living-donor lobar lung transplantation; Human; Respiratory disease; Living donor; Lung; Cardiovascular disease; Patient; Transplantation; Homotransplantation; Artery; Pulmonary hypertension; Treatment; Right ventricular function; Surgery; Graft; Anesthesia; Early; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.02.038

Objective The aim of this study was to evaluate right and left ventricular functions in patients with pulmonary arterial hypertension after living-donor lobar lung transplantation compared with those without hypertension. Methods Thirty-three recipients of living-donor lobar lung transplantation were divided into two groups: those with pulmonary arterial hypertension (PAH group; n = 12) and those without (non-PAH group; n = 21). Their systolic pulmonary artery pressure was 93.1 ± 6.7 mm Hg versus 31.4 ± 2.9 mm Hg, respectively. Right and left ventricular ejection fractions, systolic pulmonary artery pressure, and cardiac index were serially measured by radionuclide ventriculography and right heart catheterization, respectively. Results Pretransplant right and left ventricular ejection fractions were lower in the PAH group (29.8% ± 7.0%, 49.9% ± 6.6%) than in the non-PAH group (49.7% ± 3.3%, 65.2% ± 1.9%) ( P = .010, .068). Two months after living-donor lobar lung transplantation, right ventricular ejection fraction and systolic pulmonary artery pressure in the PAH group (57.3% ± 5.1%, 25.7 ± 1.8 mm Hg) improved dramatically, equal to those in the non-PAH group. In contrast, left ventricular ejection fraction and cardiac index in the PAH group (50.9% ± 3.7%, 2.66 ± 0.12 L · min−1 · m−2 ) were still significantly lower than in the non-PAH group (65.4% ± 2.8%, 3.13 ± 0.15 L · min−1 · m−2 ) ( P = .0038, .037). At 6 to 12 months, the PAH group demonstrated a significant rise in left ventricular ejection fraction and cardiac index that reached similar values in the non-PAH group measured at 2 months. These values were stable for up to 3 years. Conclusions Right ventricular function recovered early after living-donor lobar lung transplantation in the PAH group. In contrast, recovery of left ventricular function required 6 to 12 months. Improved cardiac function was sustained for up to 3 years, suggesting long-term durability of cardiac function recovery after living-donor lobar lung transplantation.