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Observational Study
. 2021 Jan 1;32(1):141-149.
doi: 10.1093/icvts/ivaa222.

Effect of a reduced donor heart right ventricular distensibility on post-heart transplant haemodynamics

Yuki Nakamura  1 , Daisuke Yoshioka  1 , Hidetsugu Asanoi  1 , Shigeru Miyagawa  1 , Yasushi Yoshikawa  1 , Hiroki Hata  1 , Ryoto Sakaniwa  2 , Koichi Toda  1 , Yoshiki Sawa  1
Affiliations
Observational Study

Effect of a reduced donor heart right ventricular distensibility on post-heart transplant haemodynamics

Yuki Nakamura et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: This study aimed to investigate the characteristics of a reduced right ventricular distensibility after heart transplant.

Methods: This study enrolled 64 adult patients who underwent heart transplant at our institution. The degree of right ventricular distensibility was quantified by calculating the difference between right atrial pressures (RAPs) of X descent and Y descent (X-Y) from the RAP waveform in right heart catheterization. Histologically, the ratio of the interstitial tissue in myocardial biopsy samples was calculated.

Results: Of the 64 patients, 35 (55%) had a reduced right ventricular distensibility at 1 week after heart transplant (X-Y > 1 mmHg, RD group), and 29 (45%) had a normal right ventricular distensibility (X-Y ≤ 1 mmHg, ND group). The mean RAP and mean pulmonary capillary wedge pressure 1 week after heart transplant in the RD group were significantly higher than that in the ND group. The mean RAP and mean pulmonary capillary wedge pressure in the RD group gradually normalized 12 weeks postoperation. The ratio of the interstitial tissue of biopsy samples significantly correlated with the X-Y value. The number of patients who required inotropic support >14 days was higher in the RD group than in the ND group.

Conclusions: Reduced donor heart distensibility was a common impairment early after heart transplant. It might result from interstitial oedema in the myocardial tissue of the donor heart. Reduced donor heart distensibility after heart transplant might be associated with early clinical outcomes; however, further investigation is required.

Keywords: Donor heart; Haemodynamics; Heart transplant; Ventricular distensibility.

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Figures

Figure 1:
Figure 1:
Flow chart showing patient enrolment and analysis of the right atrial waveform of endomyocardial biopsy samples. (A) Flow chart showing patient enrolment in this study. (B) RAP waveform obtained from patients with normal right ventricular distensibility and (C) with reduced right ventricular distensibility. (D) Endomyocardial biopsy samples stained with Masson trichrome and (E) analysed using the Dynamic Cell Count function of the BZ-II Analyzer Software. The pink and green areas indicate the interstitial and myocardial tissues, respectively. ECG: electrocardiography; RAP: right atrial pressure; RHC: right heart catheterization.
Figure 2:
Figure 2:
Time course of the parameters in right heart catheterization early after heart transplant. (A) Mean PCWP, (B) mean RAP and (C) mean CI in all patients. The P-value indicates the level of statistical significance of the differences over time model. CI: cardiac index; PCWP: pulmonary capillary wedge pressure; RAP: right atrial pressure. *P for <0.001 (vs 1 week after orthotropic heart transplant, respectively).
Figure 3:
Figure 3:
Relationship among perioperative parameters, parameters obtained by right heart catheterization and histological analysis. (A) Correlation of mean PCWP and the difference between RAP of X descent and that of Y descent. (B) Correlation of mean RAP and the difference between RAP of X descent and that of Y descent. (C) Correlation of mean PCWP and the ratio of interstitial tissue in endomyocardial biopsy samples. (D) Correlation of mean RAP and the ratio of interstitial tissue in endomyocardial biopsy samples. (E) Correlation of the difference between RAP of X descent and that of Y descent and the ratio of interstitial tissue in endomyocardial biopsy samples. (F) Correlation of CPB time and the difference between RAP of X descent and that of Y descent. (G) Correlation of CPB time and the ratio of interstitial tissue in endomyocardial biopsy samples. Red area in the figure indicates 95% confidence interval. CPB: cardiopulmonary bypass; PCWP: pulmonary capillary wedge pressure; RAP: right atrial pressure.
Figure 4:
Figure 4:
Time course of the parameters in right heart catheterization after heart transplant. (A) Mean PCWP, (B) mean RAP and (C) mean CI in patients with normal and reduced right ventricular distensibility. The P-value indicates the level of statistical significance of the difference in the repeated measures across subjects for the whole model. CI: cardiac index; ND: normal distensibility; PCWP: pulmonary capillary wedge pressure; RAP: right atrial pressure; RD: reduced distensibility. *P < 0.005, **P < 0.001 (vs 1 week after orthotropic heart transplant, respectively).
Figure 5:
Figure 5:
Kaplan–Meier curve showing freedom from all-cause mortality. ND: normal distensibility; RD: reduced distensibility.
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