Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension.
Kardiol Pol
; 78(10): 1008-1014, 2020 10 23.
Article
em En
| MEDLINE
| ID: mdl-32692025
ABSTRACT
BACKGROUND:
An increasing number of patients with endstage heart failure implies a wider use of left ventricular assist devices (LVADs). Irreversible pulmonary hypertension (PH) is a predictor of unfavorable prognosis and a contraindication to orthotopic heart transplant (OHT).AIMS:
The aim of this study was to evaluate the effect of continuousflow LVAD (CFLVAD) support on pulmonary pressure and pulmonary vascular resistance (PVR) as well as the impact of preLVAD hemodynamic parameters on survival during LVAD support.METHODS:
Data collected from 106 patients who underwent CFLVAD implantation in the years 2009 to 2018 (men, 95.3%; mean [SD] age, 51.8 [12] years; mean [SD] INTERMACS profile, 2.9 [1.6]; mean [SD] LVAD support time, 661 [520] days; followup until May 2019) were retrospectively analyzed.RESULTS:
Right heart catheterization was performed before LVAD implantation in 94 patients (88.7%), after implantation-in 31 (29.2%), and before and after implantation-in 28 (26.4%). We observed mean pulmonary artery pressure (mPAP) >25 mm Hg in 65 patients (61.3%) and PVR >2.5 Wood units in 33 patients (31.1%) before LVAD implantation. A significant improvement after CFLVAD implantation was noted in mPAP, pulmonary capillary wedge pressure, transpulmonary gradient, PVR, cardiac output (P <0.001 for all parameters), and cardiac index (P = 0.003). All patients with initially irreversible PH became eligible for OHT during LVAD support. Survival during LVAD support did not depend on initial mPAP and PVR.CONCLUSIONS:
In patients with endstage heart failure, CFLVAD support leads to a significant reduction of pre and postcapillary PH. Survival on CFLVAD support is independent of elevated mPAP and PVR before implantation, which suggests that LVADs decrease the risk associated with PH.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transplante de Coração
/
Hipertensão Pulmonar
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article