Cardiac remodelling and hemodynamic changes in pulmonary hypertension after double lung transplantation

Introduction: Pulmonary hypertension (PH) is a chronic and progressive disease characterized by vascular obstruction and gradual increasing in pulmonary vascular resistance (PVR) leading to right ventricular (RV) failure and death Objective: To study RV remodeling and hemodynamics in patients (p) with PH treated with double lung transplantation (DLTx) Methods: Analysis of demographic data, PH classification, clinical condition, surgical complications and mortality of 11 p that had undergone consecutive DLTx from January 2013 to December 2015. Hemodynamic status was analyzed pre and within 48 hours post-DLTx. Echocardiography was performed pre and within 30 days post-DLTx Results: Seven p were woman; mean age 38 years old (range 22±54). All p were in NYHA functional class III-IV. Diagnoses were: idiopathic PAH, 7 p; associated PAH to congenital heart disease, 3 p; chronic thromboembolic PH, 1 p. All p were under long-term anticoagulation, diuretics, and at least 2 PAH specific drugs. Two p required ECMO due to severe graft reperfusion injury and one of them died. Mean hospitalization was 20 days (7±54). The preoperative and postoperative hemodynamic findings were as follows: mPAPfrom 64.2 (43-96) to 16.8 (9-23) mmHg; PVR from 16 (4.5-35) to 1.35 UW (0.5-2.1); Cardiac Index from 1.98(1.5-2.97)to2.97(2.4-4.3)l/min/m2. Preop and postoperative echocardiography measurements were: Right ventricle diastolic diameter from 53 (40-72) to 35 (28-38) mm; TAPSE from 13 (9-19) to 21 (16-23) mm; right atrium area from 39 (20-85) to22 (13-36) cm2 Conclusion: Double lung transplantation has demonstrated consistent benefitial improvement in RV remodelling and pulmonary hemodynamics.