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Left ventricular assist devices decrease fixed pulmonary hypertension in cardiac transplant candidates.

Daniel Zimpfer1, Philipp Zrunek, Wilfried Roethy

  • 1Department of Cardiothoracic Surgery, Medical University of Vienna, Wahringer Guertel, Vienna, Austria. daniel.zimpfer@meduniwien.ac.at

The Journal of Thoracic and Cardiovascular Surgery
|February 27, 2007
PubMed
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Left ventricular assist devices (LVADs) significantly reduce fixed pulmonary hypertension in heart transplant candidates. This improvement allows patients to safely undergo cardiac transplantation, overcoming a major contraindication.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Devices

Background:

  • Fixed pulmonary hypertension is a critical contraindication for cardiac transplantation.
  • It significantly increases the risk of donor heart failure post-transplant.
  • Medical management often fails to adequately reduce pulmonary hypertension in these candidates.

Purpose of the Study:

  • To evaluate the efficacy of left ventricular assist devices (LVADs) in improving fixed pulmonary hypertension.
  • To determine if LVADs can enable safe cardiac transplantation for eligible candidates.
  • To assess the impact of LVADs on pulmonary vascular resistance in transplant candidates.

Main Methods:

  • A study involving 35 cardiac transplant candidates with medically resistant fixed pulmonary hypertension.

Related Experiment Videos

  • Patients received a left ventricular assist device (LVAD) as a bridge to transplantation.
  • Pulmonary vascular resistance was measured via right-sided heart catheterization before LVAD implantation and at 3-day and 6-week follow-ups.

    • Main Results:

    • LVAD implantation significantly decreased pulmonary vascular resistance from 5.1 +/- 2.8 Wood units pre-implantation to 2.9 +/- 1.3 at 3 days and 2.0 +/- 0.8 at 6 weeks (P < .0001).
    • This reduction was independent of the type of LVAD used (pulsatile or continuous flow).
    • 69% of patients (24/35) successfully bridged to transplantation with a 1-year post-transplant survival rate of 95%.

    Conclusions:

    • Left ventricular assist devices effectively decrease fixed pulmonary hypertension in cardiac transplant candidates.
    • LVADs serve as a viable option to overcome contraindications for cardiac transplantation.
    • Consideration of LVADs is recommended for all cardiac transplant candidates presenting with fixed pulmonary hypertension.