Changes in pulmonary artery pressure affect survival differently in lung transplant recipients who have pulmonary hypertension or chronic obstructive pulmonary disease.

OBJECTIVES: Pulmonary hypertension and right ventricular dysfunction can complicate lung transplant. Pulmonary artery pressures affect outcome are uncertain during wait list. We evaluated changes in wait list pulmonary artery pressures on survival after lung transplant. MATERIALS AND METHODS: We queried the United Network for Organ Sharing/Standard Transplant Analysis and Research registry from 1987 to 2012 for all lung transplants. Recipients with unique pulmonary artery pressure measurements upon listing and transplant were included. Mean pulmonary artery pressure was rated as increased (increase > 5 mm Hg), decreased (decrease > 5 mm Hg), or unchanged (variation < 5 mm Hg). RESULTS: There were 23 951 lung transplants and 1677 recipients were included. Diagnoses demonstrated significant changes in mean pulmonary artery pressure during the listing period (P ≤ .0001). In recipients with chronic obstructive pulmonary disease, survival was poorer when mean pulmonary artery pressure was increased than decreased (P ≤ .03). In recipients with primary pulmonary hypertension, survival was poorer when mean pulmonary artery pressure was decreased than increased (P ≤ .02). Proportional hazards analysis showed that increases in mean pulmonary artery pressure independently affected survival (hazard ratio, 0.78; 95% confidence interval, 0.62-0.96). CONCLUSIONS: Although the mechanism is unknown, an increase in mean pulmonary artery pressure in patients with chronic obstructive pulmonary disease is associated with poorer survival after lung transplant. In contrast, patients with primary pulmonary hypertension with decreased mean pulmonary artery pressure have poorer survival after lung transplant. In patients with primary pulmonary hypertension, changes in pulmonary artery pressure may be a surrogate for a failing right ventricular function. In chronic obstructive pulmonary disease, the change in pressure suggests an undetermined progressive process. Further study of right ventricular function is warranted to determine the effects of changes in pulmonary artery pressure on lung transplant recipients.

Early catastrophic stentless valve failure secondary to possible immune reaction.

Aortic valve replacement with stentless xenografts has become routine since their introduction in the early 1990s. Although concerns of structural valve deterioration and long-term durability have been voiced, the reports on the causes or pathology associated with early valve failure have been sparse. We report two unusual cases of failure leading to patient death within the first year after implantation of the aortic valve and root with the Freestyle prostheses (Medtronic Inc, Minneapolis, MN). We suggest an early immunologic reaction to the xenograft, leading to a fatal inflammatory process, as a mechanism for unusual early valve failure in these patients.

Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence.

BACKGROUND: Although morbid obesity rates in patients >or=65 years of age are increasing, few centers have reported weight loss surgery outcomes in elderly patients, resulting in a paucity of literature on perioperative mortality and morbidity. METHODS: A retrospective analysis was performed on 197 consecutive patients >or=65 years old who underwent weight loss surgery from January 2000 to December 2007. Primary data points included 30-day and 1-year mortality rates, length of stay (LOS), percent excess weight loss (EWL), change in daily medication use, and quality of life (QOL). RESULTS: The average patient's age was 67.3 years with 72.1% being female. Average preoperative weight and BMI were 131.9 kg and 48.1 kg/m(2), respectively. Average preoperative daily medication use was 8.04 +/- 3.67. Procedure types included Roux-en-Y gastric bypass (79.3%), adjustable gastric banding (17.2%), and vertical sleeve gastrectomy (3%). Ninety-seven percent of procedures were performed laparoscopically. Average LOS was 2.0 +/- 2.1 days. Average weight, BMI, and daily medication use were significantly reduced at 6 months and 1 year (p < 0.001), with patients achieving an average EWL of 44.5% and 55.3% at 6 months and 1 year, respectively. QOL scores improved at 6 months (p < 0.001) and 1 year (p = 0.049). In all patients, the 30-day mortality rate was 0%. The 1-year mortality rate for RYGB patients was 1.3%. Complication rates were acceptable, with 7% of RYGB patients experiencing a major postoperative complication. CONCLUSIONS: Weight loss surgery is effective in patients >or=65 years of age, producing significant EWL, reduction in daily medication use, and improvement in QOL. Surgery is also associated with a low mortality rate and an acceptable morbidity profile.