title: Pulmonary Hypertension After Heart Transplantation in Patients Bridged with the Total Artificial Heart.
abstract: Pulmonary hypertension (PH) among heart transplant recipients is associated with an increased risk of mortality. Pulmonary hemodynamics improves after left ventricular assist device (LVAD) implantation; however, the impact of PH before total artificial heart (TAH) implantation on posttransplant hemodynamics and survival is unknown. This is a single center retrospective study aimed to evaluate the impact of TAH implantation on posttransplant hemodynamics and mortality in two groups stratified according to severity of PH: high (≥3 Woods units [WU]) and low (<3 WU) baseline pulmonary vascular resistance (PVR). Hemodynamic data were obtained from right heart catheterization performed at baseline (before TAH) and posttransplant at 1 and 12 months. Patients in the high PVR group (n = 12) experienced improvement in PVR (baseline = 4.31 ± 0.7; 1-month = 1.69 ± 0.7, p < 0.001; 12-month = 48 ± 0.9, p < 0.001) and transpulmonary gradient (baseline = 15.8 ± 3.3; 1-month = 11.57 ± 5.0, p = 0.07; 12-month = 8.50 ± 4.0, p = 0.008) after transplantation, reaching similar values as the low PVR group at 12 months. The filling pressures improved in the high PVR group after heart transplantation (HT), but remained elevated. There was no significant difference in survival between the two groups at 12 months follow-up. Patients with high PVR who are bridged to transplant with TAH had improvement in PVR at 12 months after transplant, and the degree of PVR did not impact posttransplant survival.
authors.affiliation: From the *Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Hospital, Richmond, Virginia; †Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; ‡Division of Cardiology, Centra Health, Lynchburg, Virginia; and §Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University Hospital, Richmond, Virginia.
authors.forename: Rachit
authors.initials: R
authors.lastname: Shah
authors.forename: Dhavalkumar B
authors.initials: DB
authors.lastname: Patel
authors.forename: Anit K
authors.initials: AK
authors.lastname: Mankad
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Rennyson
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Tang
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Quader
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Smallfield
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
authors.forename: Keyur B
authors.initials: KB
authors.lastname: Shah
mesh_terms: D000328:Adult; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006354:Heart, Artificial; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies