41: Current status of heart transplantation as therapy for advanced heart failure in African Americans

HTx recipients in our centre 1983-2005. RHC was performed prior to and regularly after HTx. Patients with high preoperative RHC levels were tested with iv. nitroprussid to obtain 2 out of 3 criteria; Systolic pulmonary artery pressure (SAP) 50mmHg, , transpulmonary gradient 10 mmHg or pulmonary vascular resistance (PVR) 2.5WU. Median follow up 7.8 years. Results: Preoperative parameters did not influence survival. Patients in need of nitroprusside (n 103), SAP 50mmHg (n 168) or PVR 3WU (n 160) did not have poorer outcome than recipients with lower values. Independent of the preop. values, hemodynamic levels tended to normalize at 6 months postop. and stabilize at one year without further changes. Hemodynamics measured 6 months postop. predicted survival tested in a multivariate model. Recipients with PAR 1.6WU (median value) had a survival of 81% and an adjusted hazard ratio (HR) of 2.2 (95%CI 1.5-3.4), compared to 54% for the group with PAR 1.6 WU (p 0.005). Survival benefit was also observed in recipients with PAR 1.6 WU after one year (p 0.001, HR of 2.1 (95%CI 1.5-3.0)). In addition to PVR, impaired cardiac output (CO) at one year after HTx was also a significant predictor of subsequent mortality in multivariate analysis ( HR 0.59 (95%CI 0.38-0.82); p 0.042). Patients with CO 5.4l/min (median value) had a survival rate of 81% versus 55% in the lower group. Conclusions: Preop. RHC hemodynamic parameters have no prognostic value in selected HTx recipients, tending to normalize within 6 month and have no further decline after one year. PVR at 6 months post HTx is a predictor of survival while both PVR and CO at one year post HTx are predictors of life expectancy, and supports RHC as part of an early postop. follow up regime.