Agnieszka Biełka1, Mariusz Kalinowski2, Michał Hawranek3, Justyna Małyszek-Tumidajewicz2, Jerzy Pacholewicz2, Anetta Kowalczuk-Wieteska2, Katarzyna Ratman2, Grzegorz Kubiak2, Bogumiła Król4, Piotr Przybyłowski5, Marian Zembala2, Michał O Zembala2. 1. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland. abielka@gmail.com 2. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland 3. 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland 4. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; Office ofTransplant Coordination, Silesian Centre for Heart Diseases, Zabrze, Poland 5. Department of Cardiac, Vascular and Endovascular Surgery and Transplantologyin Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; 1st Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
Abstract
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.
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.
Authors: Agnieszka Dyla; Wojciech Mielnicki; Jacek Waszak; Hubert Szurmiak; Krystian Jakimowicz; Roch Pakuła; Michał Oskar Zembala Journal: Int J Environ Res Public Health Date: 2022-09-26 Impact factor: 4.614
Authors: Tomasz Dziodzio; Mariusz Kuśmierczyk; Andrzej Juraszek; Mikołaj Smólski; Piotr Kołsut; Jarosław Szymański; Paweł Litwiński; Krzysztof Kuśmierski; Joanna Zakrzewska-Koperska; Maciej Sterliński Journal: J Cardiothorac Surg Date: 2021-08-03 Impact factor: 1.637
Authors: Annika Ingvarsson; Grunde Gjesdal; Saeideh Borgenvik; Anna Werther Evaldsson; Johan Waktare; Oscar Braun; Gustav J Smith; Anders Roijer; Göran Rådegran; Carl Meurling Journal: ESC Heart Fail Date: 2022-03-23