Post-transplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices.
OBJECTIVE
We have previously shown that fixed pulmonary hypertension in cardiac transplant candidates can be lowered using left ventricular assist devices (LVADs). The post-transplant survival of these patients is uncertain as pulmonary hypertension may reappear, possibly affecting post-transplant survival.


METHODS
Between 01/2000 and 01/2005 a total of 26 cardiac transplant candidates (92% male; mean age 56.2 years) in whom fixed pulmonary hypertension was lowered by LVAD implantation (pulmonary vascular resistance (PVR) before implantation: 5.1+/-2.8wood units (WU); PVR before cardiac transplantation: 2.0+/-.9WU) underwent cardiac transplantation at our institution. These patients were age and sex matched with 52 cardiac transplant candidates without pulmonary hypertension undergoing cardiac transplantation during the same time period. Study endpoints were peri-transplant complications and long-term survival. Mean follow-up was 36+/-14 months.


RESULTS
Peri-transplant mortality was 5% in patients after LVAD therapy and 7% in patients without prior LVAD therapy (p=.089). We observed 2 cases (4%) of acute right heart failure requiring mechanical support in patients without prior LVAD therapy. None of the patients with LVAD therapy developed peri-transplant right heart failure requiring mechanical support. Incidence of other peri-transplant complications was comparable between the two groups. Log-rank (p=.124) revealed comparable long-term survival between patients with (1 year: 85%, 2 year: 85%, 3 year: 85%) and without (1 year: 90%, 2 year 82%, 3 year prior 79%) prior LVAD therapy.


CONCLUSIONS
LVAD therapy lowers fixed pulmonary hypertension in cardiac transplant candidates with fixed pulmonary hypertension. Thereafter, long-term post-transplant survival is comparable to cardiac transplant recipients without pulmonary hypertension.
Zimpfer
Daniel
D
Department of Cardiothoracic Surgery, Medical University of Vienna, Wahringer Guertel 18-20, A-1090 Vienna, Austria. daniel.zimpfer@meduniwien.ac.at
Zrunek
Philipp
P
Sandner
Sigrid
S
Schima
Heinz
H
Grimm
Michael
M
Zuckermann
Andreas
A
Wolner
Ernst
E
Wieselthaler
Georg
G
D002303:Cardiac Output, Low / Q000503:physiopathology / Q000601:surgery; D009202:Cardiomyopathies / Q000503:physiopathology / Q000601:surgery; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology