Journal of Shandong University (Health Sciences) ›› 2019, Vol. 57 ›› Issue (5): 99-104.doi: 10.6040/j.issn.1671-7554.0.2019.069

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Relationship between right cardiac insufficiency and pulmonary vascular resistance in the perioperative period of cardiac transplantation and management

CHE Dongyang1, LI Quan2, CHEN Shanliang2, YU Jianmin2, LI Min2, XU Li2, BI Yanbin2, LI Peijie2, LIU Tianqi2   

  1. 1. Clinical Medical College, Weifang Medical University, Weifang 261053, Shandong, China;
    2. Department of Cardiology Surgery, Qianfoshan Hospital Affiliated to Shandong University, Shandong Heart Transplantation Center, Jinan 250014, Shandong, China
  • Published:2022-09-27

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Abstract: Objective To investigate the relationship between right ventricular insufficiency and pulmonary vascular resistance in patients with low-output heart failure during the perioperative period and the clinical management experience. Methods The clinical data of 42 patients with end-stage heart failure undergoing orthotopic heart transplantation at 山 东 大 学 学 报 (医 学 版)57卷5期 -车东阳,等.心脏移植围术期右心功能不全与肺血管阻力的关系及处理 \=-Qianfoshan Hospital Affiliated to Shandong University during 2008 and 2018 were retrospectively analyzed, including 34 males and 8 females. The patients aged 20 to 68 years, average(49.55 ±11.58)years. According to the results of routine floating catheter examination, the patients were divided into two groups: high pulmonary vascular resistance group(PVR≥3.5 Wood, n=24)and low pulmonary vascular resistance group(PVR<3.5 Wood, n=18). The left ventricular size, left ventricular ejection fraction, cardiac output, pulmonary artery pressure, pulmonary wedge pressure, donor ischemia time, and intraoperative cardiopulmonary bypass time were recorded. Postoperative echocardiography was performed to evaluate the right ventricular size and tricuspid regurgitation on day 3 and 15. Results There were no statistical differences in the baseline data between the two groups, including gender, age, weight, preoperative left ventricular size, and ejection fraction (P>0.05). The preoperative pulmonary artery pressure was(47.79±7.78) vs(38.78±5.48)mmHg in the high pulmonary vascular resistance group and low pulmonary vascular resistance group, and the difference was statistically significant (P<0.05). The preoperative pulmonary artery wedge pressure was(29.25±7.75)vs(28.33±6.22)mmHg (P>0.05). The preoperative cardiac output was(2.96±1.24)vs(5.16±1.52)L/min (P<0.05). The intracardiac circulation time was(256.25±88.79)vs(181.11±52.59)min, and the parallel time was(147.71±84.84)vs(89.00±32.78)min(both P<0.05). On day 3 after operation, echocardiography showed that the diameter of right ventricle was(25.96±3.76)vs(22.00±4.70)mm (P<0.05), and the mean value of tricuspid regurgitation was higher in the high low pulmonary vascular resistance group than in the low pulmonary vascular resistance group (P<0.05). Conclusion There is a positive correlation between severe right ventricular insufficiency after heart transplantation and increased pulmonary vascular resistance. Patients with high pulmonary vascular resistance need longer bypass time to ensure the recovery of donor cardiac function.

Key words: Heart transplantation, Pulmonary vascular resistance, Right ventricular insufficiency, Cardiopulmonary bypass time

CLC Number: 

  • R617
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