PMID- 21256766
OWN - NLM
STAT- MEDLINE
DCOM- 20110826
LR  - 20131121
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 30
IP  - 6
DP  - 2011 Jun
TI  - Heart transplantation in children with markedly elevated pulmonary vascular 
      resistance: impact of right ventricular failure on outcome.
PG  - 659-66
LID - 10.1016/j.healun.2010.12.007 [doi]
AB  - BACKGROUND: Pulmonary hypertension causes increased morbidity and mortality in 
      adults after heart transplantation. The effect of markedly elevated pulmonary 
      vascular resistance (PVR) on post-transplant outcomes in children has not been 
      well described. METHODS: Outcomes were compared in a retrospective study between 
      58 children with an elevated PVR index (PVRI) >/= 6 U/m(2) and 205 children with a 
      PVRI < 6 U/m(2). Patients who did and did not respond to acute vasodilator 
      testing and patients who underwent transplant before (pre-1995) and after 
      (post-1995) the availability of inhaled nitric oxide (iNO) were compared. 
      RESULTS: The pre-transplant diagnoses, and cardiopulmonary bypass and donor 
      ischemic times were similar between the high and low PVRI groups. High PVRI 
      patients were older at transplant (12 +/- 6.2 vs 8 +/- 7.1 years, p = 0.002). The 
      post-transplant inotrope score was higher in the high PVRI group (12 +/- 12 vs 2 +/- 
      2, p = 0.0001) and 1-year survival was worse (76% vs 81%, p = 0.03). The PVRI 
      fell to < 6 U/m(2) with acute vasodilator testing in 21 of 49 (42%) high PVRI 
      patients. RV failure occurred in 4 (19%) of the responders and in 14 (50%) of the 
      non-responders (p = 0.037). One responder (5%) and 4 non-responders (14%) died of 
      RV failure. In the period after 1995, the year iNO became clinically available, 
      the select group of high PVRI patients who received iNO preemptively had a lower 
      incidence of post-transplant RV failure than the group that did not receive 
      preemptive iNO (13% vs 54%, p = 0.04). CONCLUSIONS: Pre-transplant vasodilator 
      testing identified patients at higher risk for RV failure. Patients who did not 
      respond to vasodilator testing had an increased incidence of RV failure and death 
      from RV failure. Preemptive use of iNO was associated with a decreased incidence 
      of RV failure.
CI  - Copyright (c) 2011 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Ofori-Amanfo, George
AU  - Ofori-Amanfo G
AD  - Division of Critical Care Medicine, Morgan Stanley Children's Hospital of New 
      York, Columbia University College of Physicians and Surgeons, NY, USA. 
      george.ofori@duke.edu
FAU - Hsu, Daphne
AU  - Hsu D
FAU - Lamour, Jacqueline M
AU  - Lamour JM
FAU - Mital, Seema
AU  - Mital S
FAU - O'Byrne, Michael L
AU  - O'Byrne ML
FAU - Smerling, Arthur J
AU  - Smerling AJ
FAU - Chen, Jonathan M
AU  - Chen JM
FAU - Mosca, Ralph
AU  - Mosca R
FAU - Addonizio, Linda J
AU  - Addonizio LJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20110122
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 31C4KY9ESH (Nitric Oxide)
SB  - IM
MH  - Administration, Inhalation
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Heart Failure/epidemiology/*etiology
MH  - Heart Transplantation/mortality/*physiology
MH  - Humans
MH  - Hypertension, Pulmonary/*complications/physiopathology
MH  - Infant
MH  - Male
MH  - Nitric Oxide/*administration & dosage
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Resistance/*physiology
MH  - Ventricular Dysfunction, Right/epidemiology/*etiology
MH  - Young Adult
EDAT- 2011/01/25 06:00
MHDA- 2011/08/30 06:00
CRDT- 2011/01/25 06:00
PHST- 2010/07/15 00:00 [received]
PHST- 2010/11/29 00:00 [revised]
PHST- 2010/12/05 00:00 [accepted]
PHST- 2011/01/25 06:00 [entrez]
PHST- 2011/01/25 06:00 [pubmed]
PHST- 2011/08/30 06:00 [medline]
AID - S1053-2498(10)00778-3 [pii]
AID - 10.1016/j.healun.2010.12.007 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2011 Jun;30(6):659-66. doi: 
      10.1016/j.healun.2010.12.007. Epub 2011 Jan 22.