JOURNAL OF HEART AND LUNG TRANSPLANTATION | 卷:34 |
Influence of right ventricular function on the development of primary graft dysfunction after Lung transplantation | |
Article | |
Perez-Teran, Purificacion1,2  Roca, Oriol1,3  Rodriguez-Palomares, Jose4  Sacanell, Judit1  Leal, Sandra1  Sole, Joan5  Rochera, Maria I.6  Roman, Antonio7  Ruiz-Rodriguez, Juan C.1  Gea, Joaquim3,8,9  Evangelista, Arturo4  Masclans, Joan R.3,9,10  | |
[1] Vall Hebron Univ Hosp, Crit Care Dept, Inst Recerca Vall Hebron VHIR, Barcelona, Spain | |
[2] Univ Autonoma Barcelona, Dept Med, E-08193 Barcelona, Spain | |
[3] Inst Salud Carlos III, CibeRes Ciber Enfermedades Respiratorias, Madrid, Spain | |
[4] Vall Hebron Univ Hosp, Dept Cardiol, Barcelona, Spain | |
[5] Vall Hebron Univ Hosp, Dept Thorac Surg, Barcelona, Spain | |
[6] Vall Hebron Univ Hosp, Dept Anesthesiol, Barcelona, Spain | |
[7] Vall Hebron Univ Hosp, Resp Dept, Barcelona, Spain | |
[8] Univ Pompeu Fabra, Barcelona, Spain | |
[9] Hosp Mar Parc Salut Mar Barcelona, Inst Hosp Mar Investigac Med IMIM, Resp Dept, Barcelona, Spain | |
[10] Hosp Mar Parc Salut Mar Barcelona, Inst Hosp Mar Investigac Med IMIM, Crit Care Dept, Barcelona, Spain | |
关键词: primary graft dysfunction; lung transplant; right ventricle; speckle-tracking echocardiography; | |
DOI : 10.1016/j.healun.2015.05.026 | |
来源: Elsevier | |
【 摘 要 】
BACKGROUND: Primary graft dysfunction (PGD) remains a significant cause of lung transplant postoperative morbidity and mortality. The underlying mechanisms of PGD development are not completely understood. This study analyzed the effect of right ventricular function (RVF) on PGD development. METHODS: A retrospective analysis of a prospectively assessed cohort was performed at a single institution between July 2010 and June 2013.. The primary outcome was development of PGD grade 3 (PGD3). Conventional echocardiographic parameters and speckle-tracking echocardiography, performed during the pre-transplant evaluation phase up to I year before surgery, were used to assess preoperative RVF. RESULTS: Included were 120 lung transplant recipients (LTr). Systolic pulmonary arterial pressure (48 +/- 20 vs 41 +/- 18 mm Hg; p = 0.048) and ischemia time (349 +/- 73 vs 306 +/- 92 minutes; p < 0.01) were higher in LTr who developed PGD3. Patients who developed PGD3 had better RVF estimated by basal free wall longitudinal strain.(BLS; -24% 9% vs -20% +/- 6%; p = 0.039) but had a longer intensive care unit length of stay and mechanical ventilation and higher 6-month mortality. BLS >= -21.5% was the cutoff that best identified patients developing PGD3 (area under the receiver operating characteristic curve, 0.70; 95% confidence interval, 0.54-0.85; p = 0.020). In the multivariate analysis, a BLS >= -21.5% was an independent risk factor for PGD3 development (odds ratio, 4.56; 95% confidence interval, 1.20-17.38; p = 0.026), even after adjusting for potential confounding. CONCLUSIONS: A better RVF, as measured by BLS, is a risk factor for severe POD. Careful preoperative RVF assessment using speckle-tracking echocardiography may identify LTrs with the highest risk of developing PGD. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.
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