Normalization of high pulmonary vascular resistance with LVAD support in heart transplantation candidates.
OBJECTIVE
Pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) lead to poor outcome after heart transplantation due to postoperative failure of the non-conditioned right ventricle. The role of continuous flow left ventricular assist device (LVAD) support in the reduction of elevated PVR was evaluated in a series of clinical implants.


METHODS
Among 17 patients with terminal heart failure receiving a MicroMed DeBakey LVAD as bridge to transplant, there were six patients with pulmonary hypertension (mean systolic PAP 47 mmHg) and high PVR (398 dynes/cm5), previously not considered suitable for heart transplantation, who underwent serial right heart catheters during their LVAD support period.


RESULTS
In these patients mean systolic pulmonary pressure dropped to 29 mmHg and PVR decreased to a mean 167 dynes/cm5 under LVAD support. Clinical improvement was significant in all patients. Four patients were successfully transplanted without major postoperative difficulties (mean duration 130 days support) and all are doing well to date. Post-transplant-PVR remained in the normal range in all transplanted patients.


CONCLUSIONS
Elevated PVR and severe PH were both previously considered as contraindication for heart transplantation. A period of LVAD pumping leads to a progressive decrease of PVR and normalization of pulmonary pressures, making these patients amenable for heart transplantation. LVAD as bridge to heart transplantation is safe and highly beneficial for terminal heart failure patients with severe PH.
Salzberg
Sacha P
SP
Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. sacha.salzberg@msnyuhealth.org
Lachat
Mario L
ML
von Harbou
Kai
K
Zünd
Gregor
G
Turina
Marko I
MI
D000328:Adult; D002303:Cardiac Output, Low / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology / Q000601:surgery