Skip to main content

Post-Transplant Right Ventricular Failure

  • Chapter
  • First Online:
Difficult Decisions in Cardiothoracic Critical Care Surgery

Abstract

The right ventricle is particularly vulnerable to acute failure during cardiac transplantation, and post-transplant right ventricular failure is associated with significant perioperative morbidity and mortality. But provided that early recognition and aggressive treatment is initiated, such right ventricular failure has a relatively high rate of recovery. Such treatment requires multimodal therapy including optimization of preload, ionotropic support, afterload reduction and if necessary, mechanical circulatory support.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Goldfarb S, Levvey BJ, et al. Transplantation: thirty-second official adult heart transplantation report – 2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34(10):1244–54.

    Article  Google Scholar 

  2. Stobierska-Dzierzek B, Awad H, Michler RE. The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol. 2001;38(4):923–31.

    Article  CAS  Google Scholar 

  3. Squiers JJ, Saracino G, Chamogeorgakis T, MacHannaford JC, Rafael AE, Gonzalez-Stawinski GV, et al. Application of the international society for heart and lung transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume center. Eur J Cardiothorac Surg. 2017;51(2):263–70.

    PubMed  Google Scholar 

  4. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 international society for heart lung transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35(1):1–23.

    Article  Google Scholar 

  5. Costard-Jäckle A, Fowler MB. Influence of preoperative pulmonary artery pressure on mortality after heart transplantation: testing of potential reversibility of pulmonary hypertension with nitroprusside is useful in defining a high risk group. J Am Coll Cardiol. 1992;19(1):48–54.

    Article  Google Scholar 

  6. Yeoh TK, Frist WH, Lagerstrom C, Kasper EK, Groves J, Merrill W. Relationship of cardiac allograft size and pulmonary vascular resistance to long-term cardiopulmonary function. J Heart Lung Transplant. 1992;11(6):1168–76.

    CAS  PubMed  Google Scholar 

  7. Kwon MH, Wong S, Kittleson M, Ardehali A, Laks H, Shemin RJ, et al. Selecting oversized donor cardiac allografts for patients with pulmonary hypertension may be unnecessary. Transplant Proc. 2014;46(5):1497–50.

    Article  CAS  Google Scholar 

  8. Ardehali A, Hughes K, Sadeghi A, Esmailian F, Marelli D, Moriguchi J, et al. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation. 2001;72(4):638–41.

    Article  CAS  Google Scholar 

  9. Solina AR, Ginsberg SH, Papp D, Grubb WR, Scholz PM, Pantin EJ, et al. Dose response to nitric oxide in adult cardiac surgery patients. J Clin Anesth. 2001;13(4):281–6.

    Article  CAS  Google Scholar 

  10. Haraldsson A, Kieler-Jensen N, Ricksten SE. Inhaled prostacyclin for treatment of pulmonary hypertension after cardiac surgery or heart transplantation: a pharmacodynamic study. J Cardiothorac Vasc Anesth. 1996;10(7):864–8.

    Article  CAS  Google Scholar 

  11. Theodoraki K, Tsiapras D, Tsourelis L, Zarkalis D, Sfirakis P, Kapetanakis E, et al. Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction. Acta Anaesthesiol Scand. 2006;50(10):1213–7.

    Article  CAS  Google Scholar 

  12. Khan TA, Schnickel G, Ross D, Bastani S, Laks H, Esmailian F, Marelli D, et al. A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients. J Thorac Cardiovasc Surg. 2009;138(6):1417–24.

    Article  CAS  Google Scholar 

  13. De Santo LS, Mastroianni C, Romano G, Amarelli C, Marra C, Maiello C, et al. Role of sildenafil in acute posttransplant right ventricular dysfunction: successful experience in 13 consecutive patients. Transplant Proc. 2008;40(6):2015–8.

    Article  Google Scholar 

  14. Singh RK, Richmond ME, Zuckerman WA, Lee TM, Giblin TB, Rodriguez R, et al. The use of oral sildenafil for management of right ventricular dysfunction after pediatric heart transplantation. Am J Transplant. 2014;14(2):453–8.

    Article  CAS  Google Scholar 

  15. Arafa OE, Geiran OR, Andersen K, Fosse E, Simonsen S, Svennevig JL. Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation. Ann Thorac Surg. 2000;70(5):1587–93.

    Article  CAS  Google Scholar 

  16. Chen JM, Levin HR, Rose EA, Addonizio LJ, Landry DW, Sistino JJ, et al. Experience with right ventricular assist devices for perioperative right-sided circulatory failure. Ann Thorac Surg. 1996;61(1):305–10.

    Article  CAS  Google Scholar 

  17. Sugiki H, Nakashima K, Vermes E, Loisance D, Kirsch M. Temporary right ventricular support with Impella Recover RD axial flow pump. Asian Cardiovasc Thorac Ann. 2009;17(4):395–400.

    Article  Google Scholar 

  18. Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36(33):2246–56.

    Article  CAS  Google Scholar 

  19. Tchantchaleishvili V, Wood KL, Carlson LA, Barrus B, Swartz MF, Vidula H, et al. Temporary mechanical circulatory support after orthotopic heart transplantation: a single-centre experience. Interact Cardiovasc Thorac Surg. 2017;25(1):41–6.

    Article  Google Scholar 

  20. Taghavi S, Zuckermann A, Ankersmit J, Wieselthaler G, Rajek A, Laufer G, et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation. Ann Thorac Surg. 2004;78(5):1644–9.

    Article  Google Scholar 

  21. Bergenfeldt H, Stehlik J, Höglund P, Andersson B, Nilsson J. Donor-recipient size matching and mortality in heart transplantation: influence of body mass index and gender. J Heart Lung Transplant. 2017;36(9):940–7.

    Article  Google Scholar 

  22. McGinn K, Reichert MA. Comparison of inhaled nitric oxide versus inhaled epoprostenol for acute pulmonary hypertension following cardiac surgery. Ann Pharmacother. 2016;50(1):22–6.

    Article  CAS  Google Scholar 

  23. Sabato LA, Salerno DM, Moretz JD, Jennings DL. Inhaled pulmonary vasodilator therapy for management of right-ventricular dysfunction after left ventricular assist device placement and cardiac transplantation. Pharmacotherapy. 2017;37:944–55.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David A. Fullerton .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bell, M.T., Fullerton, D.A. (2019). Post-Transplant Right Ventricular Failure. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-04146-5_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04145-8

  • Online ISBN: 978-3-030-04146-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics