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

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

Research output: Contribution to journalArticle

58 Citations (Scopus)

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 2010
Externally publishedYes

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Heart-Assist Devices
Pulmonary Hypertension
Heart Failure
Transplants
Pressure
Pulsatile Flow
Heart Transplantation
Pulmonary Artery
Morbidity
Lung

Keywords

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

ASJC Scopus subject areas

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

Cite this

Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support. / Torre-Amione, Guillermo; Southard, Robert E.; Loebe, Matthias; Youker, Keith A.; Bruckner, Brian; Estep, Jerry D.; Tierney, Megan; Noon, George P.

In: Journal of Heart and Lung Transplantation, Vol. 29, No. 2, 02.2010, p. 195-200.

Research output: Contribution to journalArticle

Torre-Amione, G, Southard, RE, Loebe, M, Youker, KA, Bruckner, B, Estep, JD, Tierney, M & Noon, GP 2010, 'Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support', Journal of Heart and Lung Transplantation, vol. 29, no. 2, pp. 195-200. https://doi.org/10.1016/j.healun.2009.05.030
Torre-Amione, Guillermo ; Southard, Robert E. ; Loebe, Matthias ; Youker, Keith A. ; Bruckner, Brian ; Estep, Jerry D. ; Tierney, Megan ; Noon, George P. / Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support. In: Journal of Heart and Lung Transplantation. 2010 ; Vol. 29, No. 2. pp. 195-200.
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