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International pract...
International practice heterogeneity in pre-transplant management of pulmonary hypertension related to pediatric left heart disease
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- Hopper, Rachel K (author)
- Stanford University School of Medicine
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- van der Have, Oscar (author)
- Lund University,Lunds universitet,Kärlväggsbiologi,Forskargrupper vid Lunds universitet,WCMM- Wallenberg center för molekylär medicinsk forskning,Medicinska fakulteten,Vessel Wall Biology,Lund University Research Groups,WCMM-Wallenberg Centre for Molecular Medicine,Faculty of Medicine,Skåne University Hospital
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- Hollander, Seth A (author)
- Stanford University School of Medicine
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- Dipchand, Anne I (author)
- University of Toronto
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- Perez de Sa, Valeria (author)
- Lund University,Lunds universitet,Barnanestesi och intensivvård,Forskargrupper vid Lunds universitet,Pediatric anesthesia and intensive care,Lund University Research Groups
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- Feinstein, Jeffrey A (author)
- Stanford University School of Medicine
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- Tran-Lundmark, Karin (author)
- Lund University,Lunds universitet,Kärlväggsbiologi,Forskargrupper vid Lunds universitet,WCMM- Wallenberg center för molekylär medicinsk forskning,Medicinska fakulteten,Vessel Wall Biology,Lund University Research Groups,WCMM-Wallenberg Centre for Molecular Medicine,Faculty of Medicine,Skåne University Hospital
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(creator_code:org_t)
- 2023-01-02
- 2023
- English.
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In: Pediatric Transplantation. - : Wiley. - 1399-3046 .- 1397-3142. ; 27:2, s. 1-9
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Abstract
Subject headings
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- BACKGROUND: Elevated pulmonary vascular resistance (PVR) in the setting of left heart failure may contribute to poor outcomes after pediatric heart transplant (HTx), but peri-transplant management is variable.METHODS: We sought to characterize international practice by surveying physicians at pediatric HTx centers.RESULTS: We received 49 complete responses from 39 centers in 16 countries. Most respondents are pediatric cardiologists (90%), practice at centers offering heart (86%) and lung (55%) transplant, and perform pre-HTx acute vasoreactivity testing (AVT, 88%) in patients with elevated PVR. Half (51%) reported defining a PVR cutoff for HTx eligibility as ≤6 WU m 2 (56%) post-AVT (84%). The highest post-AVT PVR ever accepted for HTx ranged from 3-14.4 (median 6) WU m 2 . To treat elevated pre-transplant PVR, phosphodiesterase type 5 inhibitors are most common (65%) followed by oxygen (31%), nitric oxide (14%), endothelin receptor antagonists (11%), and prostacyclins (6%). Nearly a third (31%) do not routinely use pulmonary vasodilators without implantation of a left ventricular assist device (LVAD). Case scenarios highlight treatment variability: in a restrictive cardiomyopathy scenario, HTx listing with post-transplant vasodilator therapy was favored, whereas in a Shone's complex patient with fixed PVR, LVAD ± pulmonary vasodilators followed by repeat catheterization was most common. Management of dilated cardiomyopathy with reactive PVR was variable. Most continue vasodilator therapy until HTx (16%), PVR normalizes (16%) or ≤6 months. CONCLUSIONS: Management of elevated PVR in children awaiting HTx is heterogenous. Evidence-based guidelines are needed to allow for longitudinal determination of optimal outcomes and standardized care.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Humans
- Child
- Hypertension, Pulmonary/complications
- Heart Transplantation
- Heart Failure/complications
- Vascular Resistance/physiology
- Heart-Assist Devices
- Vasodilator Agents
- Treatment Outcome
- Retrospective Studies
Publication and Content Type
- art (subject category)
- ref (subject category)
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