Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support

Guillermo Torre-Amione, Robert E. Southard, Matthias M. Loebe, Keith A. Youker, Brian Bruckner, Jerry D. Estep, Megan Tierney, George P. Noon

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

Background: Pulmonary hypertension associated with chronic congestive heart failure posses a significant risk of morbidity and death after heart transplantation. Isolated observations suggest that chronic ventricular unloading may lead to normalization of pulmonary pressures and thus render a patient likely to be a heart transplant candidate. Methods: This study is a retrospective analysis of 9 heart failure patients with secondary pulmonary hypertension (transpulmonary gradient [TPG] > 15 mm/Hg). Two were treated with a pulsatile left ventricular assist device (LVAD) and 7 with an axial-flow LVAD. Results: After LVAD support, mean pulmonary artery pressure decreased from 39 ± 7 to 31 ± 5 mm Hg, and the TPG decreased from 19 ± 3 to 13 ± 4 mm Hg (p < 0.01). The 1-year Kaplan-Meier survival curve for patients with pre-LVAD TPG > 15 mm Hg vs those with TPG < 15 mm Hg showed no difference in survival (p = 0.6). This finding was supported by analysis of a large multi-institutional cohort obtained from the Organ Procurement and Transplantation Network database, where no differences in survival were found in the same groups. Conclusions: Pulmonary hypertension that is secondary to congestive heart failure, as defined by a TPG > 15 mm Hg can be reversed by the use of pulsatile and axial-flow LVADs; furthermore, post-transplant survival for patients with secondary pulmonary hypertension treated with an LVAD was no different than for those without pulmonary hypertension who received LVAD support.

Original languageEnglish (US)
Pages (from-to)195-200
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume29
Issue number2
DOIs
StatePublished - Feb 1 2010
Externally publishedYes

Keywords

  • hemodynamics
  • mechanical support
  • pulmonary hypertension
  • reversal
  • transplant candidacy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Torre-Amione, G., Southard, R. E., Loebe, M. M., Youker, K. A., Bruckner, B., Estep, J. D., Tierney, M., & Noon, G. P. (2010). Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support. Journal of Heart and Lung Transplantation, 29(2), 195-200. https://doi.org/10.1016/j.healun.2009.05.030