title: Medically refractory pulmonary hypertension: treatment with nonpulsatile left ventricular assist devices.
abstract: BACKGROUND
  Severe pulmonary hypertension refractory to medical treatment is a contraindication to orthotopic heart transplantation in most centers. We report our experience in treating severe pulmonary hypertension with mechanical left ventricular unloading using implantable nonpulsatile left ventricular assist devices (LVAD) with continuous flow properties.
  
  
  METHODS
  In ten patients with severe pulmonary hypertension, refractory to medical treatment, an implantable nonpulsatile LVAD was placed for continuous mechanical left ventricular support. Pulmonary hemodynamics were assessed by right heart catheterization prior to and during LVAD implantation, and after orthotopic heart transplantation.
  
  
  RESULTS
  The mean (+/-SD) interval of nonpulsatile support was 182 (+/-118) days. Pulmonary artery pressure (mean +/- SD) significantly decreased from 42 +/- 13 to 24 +/- 5 mm Hg (p < 0.005), the transpulmonary gradient (mean +/- SD) decreased from 20 +/- 6 to 11 +/-5 mm Hg (p < 0.005), and the pulmonary vascular resistance (mean +/- SD) from 4.8 +/- 1.8 to 2.2 +/- 0.8 Wood units (p < 0.005) during an interval of one to six months of LVAD support. No significant increases in pulmonary artery pressure, transpulmonary gradient, and pulmonary vascular resistance were observed during an interval of three to six months after orthotopic heart transplantation.
  
  
  CONCLUSIONS
  This study supports that LVAD support and continuous nonpulsatile mechanical unloading of the left ventricle can reverse medically unresponsive pulmonary hypertension and render patients eligible for orthotopic heart transplantation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Münster, Münster, Germany. christian.etz@ukmuenster.de
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.forename: Henryk A
authors.initials: HA
authors.lastname: Welp
authors.forename: Tony D T
authors.initials: TD
authors.lastname: Tjan
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoffmeier
authors.forename: Ernst
authors.initials: E
authors.lastname: Weigang
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D016896:Treatment Outcome