Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

Abstract

The development of targeted therapies has transformed the outlook for patients with pulmonary arterial hypertension (PAH); however, some patients fail to achieve an adequate clinical response despite receiving maximal treatment. For these patients, lung transplantation remains an important therapeutic option, and recommendations for transplantation are included in the current European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension. Although lung transplantation is not without risk, overall long-term survival rates are good and substantial improvements in quality of life have been reported for lung transplant recipients. In this review, we describe the important considerations prior to, during and after transplantation, including the role of mechanical support, in patients with advanced PAH.

Impact of Postoperative Continuous Renal Replacement Therapy in Lung Transplant Recipients

“…LTRs with PAH are known to require hemodynamic and respiratory support immediately after transplantation due to frequently seen left ventricular (LV) failure. 1 , 11 , 12 Swift normalization of pulmonary vascular resistance, followed by an immediate upturn in cardiac output and a rapid increment in left ventricular filling, leads to drastic LV impairment in PAH patients postoperatively. Therefore, it may be reasonable to implement CRRT in the early posttransplant phase for PAH patients: the removal of a large amount of intravascular fluid can reduce preload, resulting in a reduction in cardiac output and a decrease in the capillary wedge pressure.…”

Plaučių arterijos hipertenzijos diagnostikos ir gydymo šiandienos iššūkiai

“…Bendrasis sergančiųjų PAH išgyvenamumas penkerius metus po plaučių transplantacijos siekia 52-75 proc., o 10 metų -45-66 proc. [6,14]. Baltijos šalyse pirmą kartą širdies ir plaučių komplekso transplantaciją dėl šeiminės plaučių arterijos hipertenzijos 2009 m. Kauno klinikose atliko prof. Rimantas Benetis.…”

The evolving role of interventional cardiology in the treatment of pulmonary hypertension

“…However, medical therapy has not clearly improved survival in PAH and CTEPH, 2 and as many as 35–40% of CTEPH patients are deemed inoperable or have persistent PH after PTE 13 . Furthermore, lung transplantation is limited by donor availability, and even after transplantation median survival ranges from 7 to 10 years 14 . Thus, new treatment options are needed to improve quality of life and increase long‐term survival in PH.…”