title: Effect of pulmonary vascular resistance before left ventricular assist device implantation on short- and long-term post-transplant survival.
abstract: OBJECTIVE
  Pulmonary hypertension is often considered a contraindication to orthotopic heart transplantation. Left ventricular assist device support may improve pulmonary hypertension by unloading the left ventricle, making patients eligible for transplantation. We sought to investigate the effect of continuous-flow left ventricular assist device support on pulmonary hypertension and compare post-transplantation outcomes in patients with preexisting pulmonary hypertension.
  
  
  METHODS
  Between March 2004 and December 2013, 256 potential orthotopic heart transplantation candidates underwent continuous-flow left ventricular assist device implantation at Columbia University. Preimplantation right heart catheterization data were available for 227 patients. Patients were divided into 2 groups on the basis of preimplantation pulmonary vascular resistance: low (<5 Wood units) (n = 182) and high (≥5 Wood units) (n = 45). Postimplantation and post-transplantation outcomes were compared between the groups.
  
  
  RESULTS
  Pulmonary vascular resistance in the high resistance group decreased significantly during left ventricular assist device support (P < .001). Post-transplantation in-hospital mortality was significantly higher in patients with high vascular resistance (P < .05). However, 3-year survival after transplantation was similar between groups (85.0% and 79.0% for low and high vascular resistance, respectively; P = .45).
  
  
  CONCLUSIONS
  Continuous-flow left ventricular assist device therapy reduced pulmonary vascular resistance. Subsequent orthotopic heart transplantation in patients with significantly elevated pulmonary vascular resistance resulted in higher in-hospital mortality but similar 3-year survival.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY. Electronic address: mt2993@cumc.columbia.edu.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tsukashita
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Columbia University, New York, NY.
authors.forename: Jiho
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Arthur Reshad
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009519:New York City; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D016277:Ventricular Function, Left
keywords: heart transplantation; pulmonary hypertension; ventricular assist device