Post-transplant right ventricular failure management

Czech version

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‘ workplace: Klinika anesteziologie a resuscitace, IKEM, Praha ¹; Klinika kardiologie, IKEM, Praha ²; Klinika kardiovaskulární chirurgie, IKEM, Praha ³
Published in: Anest. intenziv. Med., 24, 2013, č. 6, s. 396-402
Category: Intensive Care Medicine - Review Article

Overview

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

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Article was published in

Anaesthesiology and Intensive Care Medicine

2013 Issue 6