Tuesday, May 7, 2019

RHF in heart transplant

Q: What is the best way to anticipate Right Heart Failure (RHF) in post heart transplant patients?

Answer: If a patient has 

  • elevated pulmonary artery systolic pressure >50 mmHg, 
  • elevated PVR >3 Wood units (320 dynes-sec-cm-5) or 
  • elevated transpulmonary gradient of >15 mmHg, 

is at high risk for RHF after a transplanted heart. 

Two considerations are of utmost importance:

1. If a patient has an irreversible severe pulmonary hypertension, combined heart-lung transplantation should be considered.

2. If a patient is on chronically administered pulmonary vasodilator therapy, it should be continued during the pre-bypass period, and such therapies will likely be necessary to achieve separation from cardiopulmonary bypass (CPB) after a heart transplant.



1. De Santo LS, Romano G, Maiello C, et al. Pulmonary artery hypertension in heart transplant recipients: how much is too much? Eur J Cardiothorac Surg 2012; 42:864. 

2. Vakil K, Duval S, Sharma A, et al. Impact of pre-transplant pulmonary hypertension on survival after heart transplantation: a UNOS registry analysis. Int J Cardiol 2014; 176:595.

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