[Pulmonary arterial hypertension and heart transplantation: hemodynamic evolution and survival].
BACKGROUND: Patients with chronic heart failure and pulmonary arterial hypertension are at risk of developing fatal right graft failure after transplantation, and there is no agreement about the limit of pulmonary vascular resistance for such risk. PURPOSE: To study what the impact is on the survival of a degree of pulmonary hypertension not considered to be an exclusion for orthotopic heart transplantation and to analyze the hemodynamic profile in the minor circuit after surgery. PATIENTS AND METHODS: We studied a group of 69 patients consecutively transplanted and with followup of at least one year. Patients were classified in two groups depending on the hemodynamic factors previous to transplant: group A (without pulmonary hypertension, 22 patients) and group B (with pulmonary hypertension, 47 patients). After heart transplantation we analyzed the causes of mortality and the evolution hemodynamic profile in both groups. RESULTS: In the group of patients with pulmonary hypertension there was an increase in perioperative mortality due to graft failure (p < 0.05), although at the end of the first year, the survival rate was similar in both groups. After heart transplantation, the level of pulmonary pressures dropped in the same group, but at the end of the first year, a 17% of the patients maintains some criteria of pulmonary hypertension. CONCLUSIONS: Our results confirm that degrees of pulmonary hypertension classically not considered as an exclusion for orthotopic heart transplantation were associated with an increase mortality by graft failure. The majority of survivors after heart transplantation normalize pulmonary pressures at one year of transplantation.