Klotz Stefan, Wenzelburger Frauke, Stypmann Joerg, Welp Henryk, Drees Gabriele, Schmid Christof, Scheld Hans H
Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany.
Ann Thorac Surg. 2006 Nov;82(5):1770-3. doi: 10.1016/j.athoracsur.2006.05.114.
Pulmonary hypertension (PHT), defined as a pulmonary vascular resistance (PVR) greater than 2.5 Wood units [WU] and(or) transpulmonary gradient (TPG) greater than 12 mm Hg, is a risk factor for mortality in cardiac transplantation due to elevated postoperative right heart failure. Orthotopic heart transplantation is possible if PVR could be reversed below 2.5 WU and TPG below 12 mm Hg. We show the Muenster experience from the last 10 years.
From April 1996 to December 2005 all cardiac transplant recipients separated into patients with and without PHT were included. All patients with PHT had successful reduction (PVR < or = 2.5 WU and TPG < or = 12 mm Hg) using prostaglandin I2 or E1. Posttransplant early and late mortality and incidence of right heart failure were studied.
Two hundred seventeen patients were included in this study. Of these, 168 had normal pulmonary pressures (non-PHT group), 49 (22.6%) had reversible PHT (rev-PHT group). Mean PVR was 1.6 +/- 1.1 WU vs 2.1 +/- 1.1 WU (p < 0.01; non-PHT vs rev-PHT) and mean TPG 8.0 +/- 1.9 mm Hg vs 10.6 +/- 4.1 mm Hg (p = not significant [NS]). Thirty-day survival after orthotopic cardiac transplantation was 85% vs 78% (p = 0.150) and 10 year survival 63% vs 61% (p = NS). Right heart failure during the first 30 days after transplantation occurred in 27% in the non-PHT group and in 64% in the rev-PHT group (p = 0.035). However, in patients transplanted after 2001 it did not appear.
Cardiac transplant candidates with reversible PHT have still significantly elevated pulmonary pressures compared with patients without PHT. Despite a significantly higher risk of right heart failure, long-term survival after orthotopic cardiac transplantation was not affected.
肺动脉高压（PHT）定义为肺血管阻力（PVR）大于2.5伍德单位[WU]和（或）跨肺压差（TPG）大于12毫米汞柱，是心脏移植术后因右心衰竭加重导致死亡的一个危险因素。如果PVR能降至2.5 WU以下且TPG降至12毫米汞柱以下，则可进行原位心脏移植。我们展示了明斯特过去10年的经验。
纳入1996年4月至2005年12月期间所有接受心脏移植的患者，并分为有或无PHT的患者。所有PHT患者使用前列腺素I2或E1后PVR均成功降低（PVR≤2.5 WU且TPG≤12毫米汞柱）。研究了移植后的早期和晚期死亡率以及右心衰竭的发生率。
本研究共纳入217例患者。其中，168例肺压正常（非PHT组），49例（22.6%）有可逆性PHT（rev-PHT组）。平均PVR分别为1.6±1.1 WU和2.1±1.1 WU（p<0.01；非PHT组与rev-PHT组），平均TPG分别为8.0±1.9毫米汞柱和10.6±4.1毫米汞柱（p=无统计学意义[NS]）。原位心脏移植术后30天生存率分别为85%和78%（p=0.150），10年生存率分别为63%和61%（p=无统计学意义）。移植后前30天内，非PHT组右心衰竭发生率为27%，rev-PHT组为64%（p=0.035）。然而，2001年后接受移植的患者未出现这种情况。
与无PHT的患者相比，有可逆性PHT的心脏移植候选者的肺压仍显著升高。尽管右心衰竭风险显著更高，但原位心脏移植后的长期生存未受影响。
