Implantable left ventricular assist devices for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation

Objectives: Elevated pulmonary vascular resistance unresponsive to pharmacological intervention is a major limitation in heart transplantation. We evaluated the efficiency of an implantable left ventricular assist device to decrease pulmonary vascular resistance and to lower the risk of later orthotopic heart transplantation. Material and Methods: Six patients with end-stage heart failure and „fixed“ pulmonary hypertension (PVR 5.7±0.7) were analysed. Four patients received a TCI Heartmate, 1 patient a Novacor, and 1 patient a Jarvik 2000. Results: All patients survived the LVAD implantation, 4 patients could be discharged from hospital. Cardiac index and pulmonary artery pressure values returned to normal during the early postoperative period. After a mean support time of 191±86 days PVR had fallen to 2.0±1.2 Wood units. All patients could be transplanted successfully and five are still alive after a mean follow-up of 20.5±12.4 months. One patient suffered acute humoral rejection and died 3 months after transplantation. Table1: Pulmonary vascular resistance, cardiac index, and pulmonary pressures at baseline and after LVAD treatment prior to cardiac transplantation. PVR- pulmonary vascular resistance (Wood-Units), CI-Cardiac Index (l/min/m 2 ), PAsyst- systolic pulmonar PVR CI PAsyst PAmean PC pre VAD 5.7±0.8 1.7±0.2 64.4±17.7 46.0±12.6 28.0±10.3 post VAD 1.7±1.0 3.0±0.6 27.8±3.3 21.8±3.0 10.6±4.3 p-value 0.05 0.08 0.08 0.08 0.1 Conclusions: Mechanical support using an implantable left ventricular assist device is a very efficient approach with an acceptable risk to treat severe pulmonary hypertension in end-stage heart failure patients before heart transplantation. Adequate reduction of pulmonary vascular resistance can be expected within 3–6 months. Subsequent heart transplantation is associated with a good outcome.