Post-transplant right ventricular failure management
Authors:
Syrovátka Petr 1; Kotulák Tomáš 1; Říha Hynek 1; Pinďák Marián 1; Kramář Petr 1; Al-Hiti Hikmet 2; Málek Ivan 2; Netuka Ivan 3; Pirk Jan 3
Authors place of work:
Klinika anesteziologie a resuscitace, IKEM, Praha
1; Klinika kardiologie, IKEM, Praha
2; Klinika kardiovaskulární chirurgie, IKEM, Praha
3
Published in the journal:
Anest. intenziv. Med., 24, 2013, č. 6, s. 396-402
Category:
Intensive Care Medicine - Review Article
Summary
The presence of increased pulmonary artery pressure represents a major risk factor for post-transplant right ventricular failure. In principle the donor heart, which is not adapted to elevated pulmonary vascular resistance, is exposed to pulmonary hypertension in the recipient. Postoperative right ventricular dysfunction is a major cause of morbidity and mortality and despite advances in the peri-operative management, right ventricular dysfunction accounts for 20 % postoperative complications and early deaths in patients after heart transplantation. The presence, grade and reversibility of pulmonary hypertension has to be defined by cardiac catheterization, which forms an important part of pre-operative evaluation and selection of candidates for heart transplantation. Fixed pulmonary hypertension is considered a contraindication for orthotopic heart transplantation. In all heart transplant candidates with severe fixed pulmonary hypertension, implantation of left ventricular assist device should be considered to achieve a significant decrease of pulmonary vascular resistance to acceptable values for heart transplantation. Treatment goals in right ventricular failure include preserving coronary perfusion through maintenance of mean arterial pressure, increasing contractility, optimizing right ventricular preload, reducing afterload by decreasing pulmonary vascular resistance, limiting pulmonary vasoconstriction through ventilation with high inspired oxygen concentration and the treatment of arrhythmia. The right ventricular assist device should be implanted when, despite all pulmonary hypertension treatment measures, the right ventricle progressively fails. The implantation should be done timely before the development of multiple organ failure.
Keywords:
heart failure – heart transplantation – right ventricle – pulmonary hypertension
Zdroje
1. Málek, I. Transplantace srdce – Pohled kardiologa. 1. vyd. Praha: Triton, 2004, 108 s. ISBN 80-7254-510-8.
2. Griepp, R., Stinson, E., Dong, E. Jr., Clark, D. A., Shumway, N. E.Determinants of operative risk in human heart transplantation. Am. J. Surg., 1971, 122, p. 192–197.
3. Haddad, F., Couture, P., Tousignant, C., Denault, A. Y. The right ventricle in cardiac surgery, a perioperative perspective:II. Pathophysiology, clinical importance, and management. Anesth. Analg., 2009, 108, p. 422–433.
4. Voelkel, N. F., Quaife, R. A., Leinwand, L. A., Barst, R. J., McGoon, M. D., Meldrum, D. R., Dupuis, J., Long, C. S., Rubin, L. J., Smart, F. W., Suzuki, Y. J., Gladwin, M., Denholm, E. M., Gail, D. B. Right ventricular function and failure: Report of national heart, lung, and blood institute working group on cellular and molecular mechanisms of right heart failure. Circulation, 2006, 114, p. 1883–1891.
5. Kakáč, J., Málek, I., Hrnčárek, M., Želízko, M., Staněk, V. Testování plicní hypertenze u kandidátů ortotopické transplantace srdce pomocí prostaglandinu. E1. Cor. Vasa., 1996, 38, p. 251–255.
6. Reichenbach, A., Al-Hiti, H., Málek, I., Pirk, J., Goncalvesová, E., Kautzner, J., Melenovský, V. The effects of phosphodiesterase 5 inhibition on hemodynamics, functional status and survival in advanced heart failure and pulmonary. Int. J. Cardiol., 2012. Dostupné na www: http://dx.doi.org/10.1016/j.ijcard.2012.09.074.
7. Kettner, J., Dorazilová, Z., Netuka, I., Malý, J., Al-Hiti, H., Melenovský, V., Skalský, I., Říha, H., Málek, I., Kautzner, J., Pirk, J.Is severe pulmonary hypertension a contraindication for orthotopic heart transplantation? Not any more. Physiol. Res., 2011, 60, p. 769–775.
8. Ho, S. Y., Nihoyannopoulos, P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart, 2006, 92, 1, p. 2–13.
9. Redington, A. N., Gray, H. H., Hodson, M. E., Rigby, M. L., Oldershaw, P. J. Characterisation of the normal right ventricular pressure-volume relation by biplane angiography and simulta-neous micromanometer pressure measurements. Br. Heart. J., 1988, 59, p. 23–30.
10. Rudski, L. G., Lai, W. W., Afilalo, J., Hua, L., Handschumacher, M. D., Chandrasekaran, K., Solomon, S. D., Louie, E. K., Schiller, N. B. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. J. Am. Soc. Echocardiogr., 2010, 23, p. 685–713.
11. Stobierska-Dzierzek, B., Awad, H., Michler, R. E. Management of Acute Right Heart Failure in Transplant Recipients. JACC, 2001, 38, 4, p. 923–931.
12. Mercat, A., Diehl, J. L., Meyer, G., Teboul, J. L., Sors, H. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit. Care Med., 1999, 27, p. 540–544.
13. Feissel, M., Michard, F., Mangin, I., Ruyer, O., Faller, J. P., Teboul, J. L. Respiratory Changes in Aortic Blood Velocity as an Indicator of Fluid Responsiveness in Ventilated Patients With Septic Shock. Chest, 2001, 119, p. 867–873.
14. Wagner, F. Monitoring and management of right ventricular function following cardiac transplantation. Applied Cardiopulmonary Pathophysiology, 2011, 15, p. 220–229.
15. Moraes, D. L., Colucci, W. S., Givertz, M. M. Secondary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management. Circulation, 2000, 102, p. 1718–1723.
16. Haraldsson, A., Kieler-Jensen, N., Nathorst-Westfeld, U., Bergh, C. H., Ricksten, S. E. Comparison of inhaled nitric oxide and inhaled aerosolized prostacyclin in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance. Chest, 1998, 114, p. 780–786.
17. Nishimura, M., Hess, D., Kacmarek, R. M., Ritz, B.,Hurford, W. E. Nitrogen dioxide production during mechanical ventilation with nitric oxide in adults. Effects of ventilator internal volume, air versus nitrogen dilution, minute ventilation, and inspired oxygen fraction. Anesthesiology, 1995, 82, p. 1246–1254.
18. Cuthbertson, B. H., Dellinger, P., Dyar, O. J., Evans, T. E., Higgenbottam, T., Latimer, R., Payen, D., Stott, S. A., Webster, N. R., Young, J. D. UK guidelines for the use of inhaled nitric oxide therapy in adult ICU’s. American-European Consensus Conference on ALI/ARDS. Intensive Care Med., 1997, 23, p. 1212–1218.
19. Carrier, M., Blaise, G., Belisle, S., Perfault, L. P., Pellerin, M., Petitclerc, R., Pelletier, L. C. Nitric oxide inhalation in the treatment of primary graft failure following heart transplantation.J. Heart Lung Transplant, 1999, 18, p. 664–667.
20. Maruszewski, M., Zakliczynski, M., Przybylski, R., Kucewicz--Czech, E., Zembala, M. Use of sildenafil in heart transplant recipients with pulmonary hypertension may prevent right heart failure. Transplant. Proc., 2007, 39, p. 2850–2852.
21. Channick, R. N., Simonneau, G., Sitbon, O., Robbins, I. M., Frost, A., Tapson, V. F., Badesch, D. B., Roux, S., Rainision, M., Bodin, F., Rubin, L. J. Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hyperten-sion: a randomised placebo- controlled study. Lancet, 2001, 358, p. 1119–1123.
22. Ošťádal, B., Widimský, J. Intermitent hypoxia and cardiopulmonary system. Academia Praha, 1985, 95, 3, p. 92.
23. Fischer, L. G., Van, A. H., Burkle, H. Management of pulmonary hypertension: physiological and pharmacological considera-tions for anesthesiologists. Anesth. Analg., 2003, 96, p.1603–1616.
24. Costanzo, M. R., Dipchand, A., Starling, R., Anderson, A., Chan, M., Desai, S., Fedson, S., Fisher, P., Gonzales-Stawinski, G.,Martinelli, L., McGiffin, D., Parisi, F., Smith, J. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J. Heart Lung Transplant., 2010, 29, 8, p. 914–956.
25. Mentzer, R. M., Alegre, C. A., Nolan, S. P. The effects of dopamine and isoproterenol on the pulmonary circulation. J. Thorac. Cardiovasc. Surg., 1976, 71, p. 807–814.
26. Colluci, W. S. Cardiovascular effects of milrinone. Am. Heart J., 1991, 121, p. 1945–1947.
27. Chen, E. P., Bittner, H. B., Davis, R. D., Van Trigt, P. Hemodynamic and inotropic effects of milrinone after heart transplantation in the setting of recipient pulmonary hypertension.J. Heart Lung Transplant., 1998, 17, p. 669–678.
28. Kerbaul, F., Rondelet, B., Demester, J. P., Fesler, P., Huez, S., Naeije, R., Brimioulle, S. Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure. Crit. Care Med., 2006, 34, p. 2814–2819.
29. Missant, C., Rex, S., Segers, P., Wouters, P. F. Levosimendan improves right ventriculovascular coupling in a porcine model of right ventricular dysfunction. Crit. Care Med., 2007, 35, p. 707–715.
30. Netuka, I., Malý, J., Szarszoi, O., Říha, H., Turek, D., Urban, M.,Skalský, I., Kotulák, T., Dorazilová, Z., Pirk, J. Technika implantace a zkušenosti s dočasnou mechanickou srdeční podporou při selhání pravé komory. Rozhl. Chir., 2011, 90, 2, p. 88–94.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2013 Číslo 6
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