Effect of pulmonary vascular resistance before left ventricular assist device implantation on short- and long-term post-transplant survival.
J Thorac Cardiovasc Surg
; 150(5): 1352-60, 1361.e1-2, 2015 Nov.
Article
en En
| MEDLINE
| ID: mdl-26253875
ABSTRACT
OBJECTIVES:
Pulmonary hypertension is often considered a contraindication to orthotopic heart transplantation. Left ventricular assist device support may improve pulmonary hypertension by unloading the left ventricle, making patients eligible for transplantation. We sought to investigate the effect of continuous-flow left ventricular assist device support on pulmonary hypertension and compare post-transplantation outcomes in patients with preexisting pulmonary hypertension.METHODS:
Between March 2004 and December 2013, 256 potential orthotopic heart transplantation candidates underwent continuous-flow left ventricular assist device implantation at Columbia University. Preimplantation right heart catheterization data were available for 227 patients. Patients were divided into 2 groups on the basis of preimplantation pulmonary vascular resistance low (<5 Wood units) (n = 182) and high (≥5 Wood units) (n = 45). Postimplantation and post-transplantation outcomes were compared between the groups.RESULTS:
Pulmonary vascular resistance in the high resistance group decreased significantly during left ventricular assist device support (P < .001). Post-transplantation in-hospital mortality was significantly higher in patients with high vascular resistance (P < .05). However, 3-year survival after transplantation was similar between groups (85.0% and 79.0% for low and high vascular resistance, respectively; P = .45).CONCLUSIONS:
Continuous-flow left ventricular assist device therapy reduced pulmonary vascular resistance. Subsequent orthotopic heart transplantation in patients with significantly elevated pulmonary vascular resistance resulted in higher in-hospital mortality but similar 3-year survival.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Arteria Pulmonar
/
Resistencia Vascular
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Corazón Auxiliar
/
Función Ventricular Izquierda
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Trasplante de Corazón
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Insuficiencia Cardíaca
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Hipertensión Pulmonar
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Thorac Cardiovasc Surg
Año:
2015
Tipo del documento:
Article