Introduction
: Pulmonary hypertension is a frequent sequelae of end-stage heart failure and remains a contraindication for cardiac transplantation. Pulsatile LVADs have been shown to effectively reduce pulmonary hypertension in these patients. However, it remains to be seen if newer continuous flow LVADs have a similar effect on pulmonary hypertension. The objective of this study was to determine if the Heartmate (HM) II, a continuous flow LVAD is effective in improving pulmonary hemodynamics in bridge-to-transplant patients.
Methods
: 30 patients with end-stage heart failure underwent placement of HM II LVAD as a bridge-to-transplant (BTT) at a single center. Pulmonary hemodynamics were evaluated with right heart catheterization at baseline, after placement of an intra-aortic balloon pump (IABP), and post-LVAD (prior to heart transplant).
Results
: Demographic data of these patients were as follows: mean age 51.6 ± 13.3 years, 70% male, LVEF 14.7 ± 5.11%, 56.6% ischemic etiology and 83.3% received IABP prior to LVAD. Following LVAD support (mean duration of 146. 41 ± 73.83 days), systolic and diastolic pulmonary artery pressures (SPAP and DPAP) decreased significantly (SPAP 56.8 ± 13.55 mmHg, DPAP 28.27 ± 6.23 mmHg to SPAP 35.38 ± 10.23 mmHg, DPAP 15.71 ± 5.36 mmHg; p < 0.001). Similarly, pulmonary vascular resistance (PVR) decreased significantly from 3.69 ± 2.02 to 2.00 ± 0.85 Woods units (p = 0.004). Transpulmonary gradient (TPG) also declined significantly post-LVAD from 13.3 ± 5.6 to 9.35 ± 2.98 mmHg (p = 0.02).
Conclusion
: Continuous flow LVADs effectively improve pulmonary hemodynamics associated with end-stage heart failure. Therefore, adequate left ventricular decompression achieved with continuous flow LVAD support can reverse significant pulmonary hypertension in end-stage heart failure patients making them eligible for cardiac transplantation.
Is there a role for upper-extremity intra-aortic balloon counterpulsation as a bridge-to-recovery or a bridge-to-transplant in the treatment of end-stage heart failure?
