Masaki Tsukashita1, Hiroo Takayama2, Koji Takeda2, Jiho Han3, Paolo C Colombo4, Melana Yuzefpolskaya4, Veli K Topkara4, Arthur Reshad Garan4, Donna M Mancini4, Paul A Kurlansky5, Yoshifumi Naka2. 1. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY. Electronic address: mt2993@cumc.columbia.edu. 2. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY. 3. Columbia University, New York, NY. 4. Department of Medicine Cardiology, Columbia University, College of Physicians and Surgeons, New York, NY. 5. Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY.
Abstract
OBJECTIVES: 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.
OBJECTIVES: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: David W Bearl; Debra A Dodd; Cary Thurm; Matt Hall; Jonathan H Soslow; Brian Feingold; Justin Godown Journal: Pediatr Cardiol Date: 2018-12-13 Impact factor: 1.655
Authors: Hilmi Alnsasra; Rabea Asleh; Sarah D Schettle; Naveen L Pereira; Robert P Frantz; Brooks S Edwards; Alfredo L Clavell; Simon Maltais; Richard C Daly; John M Stulak; Andrew N Rosenbaum; Atta Behfar; Sudhir S Kushwaha Journal: J Am Heart Assoc Date: 2019-08-14 Impact factor: 5.501
Authors: Rasmus Rivinius; Matthias Helmschrott; Arjang Ruhparwar; Bastian Schmack; Fabrice F Darche; Dierk Thomas; Tom Bruckner; Andreas O Doesch; Hugo A Katus; Philipp Ehlermann Journal: ESC Heart Fail Date: 2020-02