1 research outputs found
Persistence of pulmonary hypertension in patients undergoing ventricular assist devices and orthotopic heart transplantation
Abstract Pulmonary hypertension (PH) is common in advanced heart failure and often improves quickly after left ventricular assist device (VAD) implantation or orthotopic heart transplantation (OHT), but longâterm effects and outcomes are not wellâdescribed. This study evaluated PH persistence after VAD as destination therapy (VADâDT), bridge to transplant (VADâOHT), or OHTâalone. The study constituted a retrospective review of patients who underwent VADâDT (nâ=â164), VADâOHT (nâ=â111), or OHTâalone (nâ=â138) at a single tertiaryâcare center. Right heart catheterization (RHC) data was collected preâ, postâintervention (VAD and/or OHT), and 1âyear from final intervention (latestâRHC) to evaluate the longitudinal hemodynamic course of right ventricular function and pulmonary vasculature. PH (Group II and Group I) definitions were adapted from expert guidelines. All groups showed significant improvements in mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure (PAWP), cardiac output, and pulmonary vascular resistance (PVR) at each RHC with greatest improvement at postâintervention RHC (postâVAD or postâOHT). PH was reduced from 98% to 26% in VADâOHT, 92%â49% in VADâDT, and 76%â28% in OHTâalone from preintervention to latestâRHC. At latestâRHC mPAP remained elevated in all groups despite normalization of PAWP and PVR. VADâsupported patients exhibited suppressed pulmonary artery pulsatility index (PaPiâ<â3.7) with improvement only posttransplant at latestâRHC. Posttransplant patients with PH at latestâRHC (nâ=â60) exhibited lower survival (HR: 2.1 [95% CI: 1.3â3.4], pâ<â0.001). Despite an overall significant improvement in pulmonary pressures and PH proportion, a notable subset of patients exhibited PH postâintervention. Postâintervention PH was associated with lower posttransplant survival