Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension
| Autor: | Katarzyna Ratman, Grzegorz Kubiak, J. Malyszek-Tumidajewicz, Marian Zembala, Michał Zembala, Agnieszka Biełka, Piotr Przybyłowski, Mariusz Kalinowski, Jerzy Pacholewicz, Michał Hawranek, Bogumiła Król, Anetta Kowalczuk-Wieteska |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Cardiac output Hypertension Pulmonary medicine.medical_treatment Cardiac index 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery Humans Medicine Pulmonary wedge pressure Retrospective Studies Heart Failure Heart transplantation business.industry Middle Aged equipment and supplies medicine.disease Pulmonary hypertension Treatment Outcome medicine.anatomical_structure Heart failure Pulmonary artery Cardiology Vascular resistance Heart Transplantation Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Popis: | Background: An increasing number of patients with end‑stage heart failure implies a wider use of left ventricular assist devices (LVADs). Irreversible pulmonary hypertension (PH) is a predictor of unfavorable prognosis and a contraindication to orthotopic heart transplant (OHT). Aims: The aim of this study was to evaluate the effect of continuous‑flow LVAD (CF‑LVAD) support on pulmonary pressure and pulmonary vascular resistance (PVR) as well as the impact of pre‑LVAD hemodynamic parameters on survival during LVAD support. Methods: Data collected from 106 patients who underwent CF‑LVAD implantation in the years 2009 to 2018 (men, 95.3%; mean [SD] age, 51.8 [12] years; mean [SD] INTERMACS profile, 2.9 [1.6]; mean [SD] LVAD support time, 661 [520] days; follow‑up until May 2019) were retrospectively analyzed. Results: Right heart catheterization was performed before LVAD implantation in 94 patients (88.7%), after implantation—in 31 (29.2%), and before and after implantation—in 28 (26.4%). We observed mean pulmonary artery pressure (mPAP) > 25 mm Hg in 65 patients (61.3%) and PVR > 2.5 Wood units in 33 patients (31.1%) before LVAD implantation. A significant improvement after CF‑LVAD implantation was noted in mPAP, pulmonary capillary wedge pressure, transpulmonary gradient, PVR, cardiac output (P < 0.001 for all parameters), and cardiac index (P = 0.003). All patients with initially irreversible PH became eligible for OHT during LVAD support. Survival during LVAD support did not depend on initial mPAP and PVR. Conclusions: In patients with end‑stage heart failure, CF‑LVAD support leads to a significant reduction of pre‑ and postcapillary PH. Survival on CF‑LVAD support is independent of elevated mPAP and PVR before implantation, which suggests that LVADs decrease the risk associated with PH. |
| Databáze: | OpenAIRE |
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