Right Ventricular Stroke Work Index and Its Prognostic Value in a Lung Transplant Population With Group 3 Pulmonary Hypertension.

BACKGROUND

Lung transplantation requires meticulous preoperative assessment. Recipients with Group 3 pulmonary hypertension can be at higher risk of mortality and primary graft dysfunction (PGD). We conducted a study to determine whether the right ventricular stroke work index (RVSWI), a right-heart catheterisation haemodynamic indicator assessing right ventricle function, could predict 1-year survival in this setting.

METHODS

Monocentric, retrospective, observational cohort study approved by our local ethics review board, between January 2013 and December 2023. We included lung transplant recipients who underwent preprocedural right-heart catheterisation assessment and presented with Group 3 pulmonary hypertension. We first determined a clinically relevant RVSWI threshold. The primary endpoint was mortality at 1 year amongst two groups of patients according to this threshold.

RESULTS

66 patients (age 57.0 ± 11.4 years, male 56%) were included amongst a study population of 699 patients. Double-lung transplantations represented most of the procedures (91%). In univariate analysis, RVSWI was statistically associated with PGD Grade 3 at Day 3 and intraoperative veno-arterial extracorporeal membrane oxygenation (ECMO) at a threshold of RVSWI = 13.5. Mortality at 1 year did not differ between the groups RVSWI ≤ 13.5 (6 patients, 14.6%) and RVSWI > 13.5 (6 patients, 24%) even after accounting for potential confounding factors.

CONCLUSIONS

In our lung transplant population with Group 3 pulmonary hypertension, RVSWI was not associated with mortality at 1 year. A higher RVSWI seemed associated with significant events such as intraoperative ECMO and PGD Grade 3. Further studies are needed to assess RVSWI's prognostic value in this setting.