February 23, 2012

What is high risk? Redefining elevated pulmonary vascular resistance index in pediatric heart transplantation


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The risk of right heart failure early post transplant has lead some centers to avoid cardiac transplant in children with a pulmonary vascular resistance index (PVRi) >6 Wu x m2. However, this number is not universally agreed upon.  This retrospective, single center review of 158 cardiomyopathy patients transplanted between 1984-2010 examined the role of elevated PVRi on early post-transplant outcomes (30-day mortality). All patients who underwent a cardiac catheterization pretransplant according to the institutional protocol, including the introduction of pulmonary vasodilators and inotropes, were included. Using an ROC curve the authors identified a PVRi of 9.290 as a cut off for all cause 30-day mortality.  When patients were divided into two groups, those with a PVRi < 9 and those with a PVRi >9, the odds for 30 day mortality significantly increased [OR 53.42, (CI 4.33-659.57)]. While this study has some limitations it does bring into question whether the traditional parameters for PVRi in children with cardiomyopathy may be too restrictive especially given the available strategies for managing pulmonary hypertension.

Cardiac Transplantation

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