Does pretransplant left ventricular assist device therapy improve results after heart transplantation in patients with elevated pulmonary vascular resistance?

Liden, Hans; Haraldsson, Åsa; Ricksten, Sven-Erik; Kjellman, Ulf; Wiklund, Lars
June 2009
European Journal of Cardio-Thoracic Surgery;Jun2009, Vol. 35 Issue 6, p1029
Academic Journal
Abstract: Objective: Pulmonary hypertension (PH), defined as a pulmonary vascular resistance (PVR) >2.5Wood units (WU) and (or) a transpulmonary gradient (TPG) >12mmHg, is an established risk factor for mortality in heart transplantation. Elevated PVR in heart transplant candidates can be reduced using a left ventricular assist device (LVAD), and LVAD is proposed to be the treatment of choice for candidates with PH. We analyzed the effect on PVR of pretransplant LVAD therapy in patients with PH and compared posttransplant outcome with matched controls. Long-term survival was compared between heart transplant recipients with mild, moderate or severe PH and patients with no PH. Methods: Heart transplant recipients 1988–2007 (n =405) were reviewed and divided into two groups with respect to pretransplant PVR: <2.5WU (n =148) and >2.5WU (n =158). From the group with PH, patients subjected to pretransplant LVAD therapy (n =11) were analyzed with respect to PVR at implant and at transplant and, with respect to outcome, compared to matched historical controls (n =22). Patients with PH without LVAD treatment (n =147) were stratified into three subgroups: mild, moderate and severe PH and survival according to Kaplan–Meier was analyzed and compared to patients with no PH. Results: LVAD therapy reduced PVR from 4.3±1.6 to 2.0±0.6WU, p <0.05. Three cases of perioperative heart failure required mechanical support whereas one control patient developed perioperative right heart failure requiring mechanical support. The incidence of other perioperative complications was comparable between groups. There was no difference in survival between LVAD patients and controls, 30-day survival was 82% and 91%, respectively and 4-year survival was 64% and 82%, respectively. Conclusions: Pretransplant LVAD therapy reduces an elevated PVR in heart transplant recipients, but there was no statistically significant difference in posttransplant survival in patients with PH with, or without LVAD therapy. The study revealed no differences in survival in patients regardless of the severity of the PH.


Related Articles

  • Low Serum Cholesterol Levels Predict High Perioperative Mortality in Patients Supported by a Left-Ventricular Assist System. Richartz, Barbara M.; Radovancevic, Branislav; Frazier, O. Howard; Vaughn, William K.; Taegtmeyer, Heinrich // Cardiology;1998, Vol. 89 Issue 3, p184 

    Background: Although the use of a left-ventricular assist system (LVAS) provides circulatory support for end-stage heart failure patients awaiting heart transplantation, this procedure is accompanied by a relatively high perioperative mortality. The aim of this retrospective study was to...

  • IMPACTUL HIPERTENSIUNII PULMONARE ASUPRA INTERVENÅ¢IILOR CHIRURGICALE CARDIACE. Corciovă, Flavia Cătălina; Bartoş, Oana; Anghel, Diana; Enache, M.; Corciovă, C.; Tinică, G. // Jurnalul de Chirurgie;2012, Vol. 8 Issue 3, p277 

    BACKGROUND: Pulmonary hypertension (PH) is a frequent condition in patients with congenital heart diseases and left ventricle diseases. Preoperative PH causes higher mortality rate after heart surgery and adverse cardiac events. METHODS: We performed a prospective study which included 159...

  • Is preoperative levosimendan indicated to treat normal left ventricular function and left ventricle outflow obstruction? Guarracino, F.; Tritapepe, L. // BJA: The British Journal of Anaesthesia;Aug2011, Vol. 107 Issue 2, p276 

    No abstract available.

  • Management of Adult Patients with Perioperative Pulmonary Hypertension: Technical Aspects and Therapeutic Options. Winterhalter, Michael; Antoniou, Theofani; Loukanov, Tsvetomir // Cardiology;2010, Vol. 116 Issue 1, p3 

    Pulmonary hypertension (PH) is an independent risk factor for increased mortality in patients undergoing heart surgery. Existing chronic PH may be exacerbated by acute post-bypass PH, and this can lead to acute right ventricular failure. The prevention and treatment of right ventricular failure...

  • Algorithm developed to predict need for RV support post-LVAD. Young, James B. // Cardiology Today;Jun2008, Vol. 11 Issue 6, p14 

    The article focuses on the data reviewed by J.R. Fitzpatrick III, MD, general surgery resident, division of cardiac surgery at the Hospital of the University of Pennsylvania and his colleagues related to determination of preoperative risks factors for a need for an RV assist device (RVAD) after...

  • Current Trends in Implantable Left Ventricular Assist Devices. Garbade, Jens; Bittner, Hartmuth B.; Barten, Markus J.; Mohr, Friedrich-Wilhelm // Cardiology Research & Practice;2011, p1 

    The shortage of appropriate donor organs and the expanding pool of patients waiting for heart transplantation have led to growing interest in alternative strategies, particularly in mechanical circulatory support. Improved results and the increased applicability and durability with left...

  • Left ventricular assist devices. Birks, E. J. // Heart;Jan2010, Vol. 96 Issue 1, p63 

    Left ventricular assist device (LVAD) insertion in patients with advanced heart failure with deteriorating clinical status is life saving, and LVADs are now being inserted into an increasing number of patients with advanced heart failure. They were initially inserted as a bridge to...

  • Is there a place for angiotensin receptor-neprilysin inhibitors in the treatment of heart failure patients after heart transplantation? Gulin, Dario; Planinic, Zrinka; Habek, Jasna; Sikic, Jozica // Indian Journal of Pharmacology;Nov/Dec2019, Vol. 51 Issue 6, p413 

    We present a case report of a heart failure patient after heart transplantation due to end-stage ischemic cardiomyopathy with significant clinical and echocardiographic improvement 3 months after the introduction of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor. This new...

  • Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR. CODREANU, I.; ROBSON, M. D.; RIDER, O. J.; PEGG, T. J.; DASANU, C. A.; JUNG, B. A.; CLARKE, K.; HOLLOWAY, C. J. // British Journal of Radiology;Nov2013, Vol. 86 Issue 1031, p1 

    Objective: Obtaining new details for rotational motion of left ventricular (LV) segments using velocity encoding cardiac MR and correlating the regional motion patterns to LV insertion sites. Methods: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics