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

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.