title: Implantable left ventricular assist device for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation-a preliminary study.
abstract: OBJECTIVE
  Elevated pulmonary vascular resistance (PVR) unresponsive to pharmacological intervention is a major limitation in heart transplantation (HTX). The post-operative course of these patients is associated with an increased risk of life-threatening right heart failure. We evaluated the efficiency of an implantable left ventricular assist device (LVAD) to decrease PVR by unloading the left ventricle and to lower the risk of later orthotopic HTX.
  
  
  METHODS
  Six patients with end-stage heart failure (NYHA class IV) and 'fixed' pulmonary hypertension (PVR 5.7+/-0.7, range 4.4-6.5 Wood units) were analyzed. Despite maximal pharmacological intervention at initial evaluation (oxygen inhalation, nitrates, alprostadil infusion) PVR could not be reduced to under 2.5 Wood units. Four patients received a TCI Heartmate, one patient a Novacor, and one patient a Jarvik 2000.
  
  
  RESULTS
  All patients survived the LVAD implantation, four patients could be discharged from hospital. Cardiac index and pulmonary artery pressure values returned to normal during the early post-operative phase. After a mean support time of 191+/-86 days PVR had fallen to 2.0+/-1.2 (range 0.8-3.6) Wood units. All patients could be bridged to transplantation, one patient died 3 months after transplant, five patients are still alive after a mean follow-up of 16.2+/-10.5 months.
  
  
  CONCLUSIONS
  Mechanical support using an implantable LVAD is a very efficient approach with an acceptable risk to treat severe pulmonary hypertension in end-stage heart failure patients before HTX. Adequate reduction of PVR can be expected within 3-6 months. Subsequent HTX is associated with a good outcome.
authors.affiliation: Department of Cardiovascular Surgery, Albert-Ludwigs-University Medical Center, Hugstetter Str. 55, D-79106 Freiburg, Germany. martin@ch11.ukl.uni-freiburg.de
authors.forename: Juergen
authors.initials: J
authors.lastname: Martin
authors.forename: Michael P
authors.initials: MP
authors.lastname: Siegenthaler
authors.forename: Ortwin
authors.initials: O
authors.lastname: Friesewinkel
authors.forename: Tina
authors.initials: T
authors.lastname: Fader
authors.forename: Andreas
authors.initials: A
authors.lastname: van de Loo
authors.forename: Georg
authors.initials: G
authors.lastname: Trummer
authors.forename: Michael
authors.initials: M
authors.lastname: Berchtold-Herz
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome