Post-transplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices

Abstract

LVAD therapy lowers fixed pulmonary hypertension in cardiac transplant candidates with fixed pulmonary hypertension. Thereafter, long-term post-transplant survival is comparable to cardiac transplant recipients without pulmonary hypertension.

Cavopulmonary anastomosis improves left ventricular assist device support in acute biventricular failure☆☆☆

“…Nevertheless, pulmonary hypertension may be successfully managed in several patients by using conventional pulmonary vasodilators or nitric oxide inhalation [1]. Furthermore, the improvement of the circulatory response obtained by LVAD support can reverse medically unresponsive pulmonary hypertension [20,21], facilitating the long-term performance of the Glenn shunt. On the other hand, numerous patients with indication to heart transplantation did not present important pulmonary hypertension in presence of chronic biventricular failure, as observed in Chagas disease cardiomyopathy [22].…”

Selection of Cardiac Transplantation Candidates in 2010

“…56 However, modern therapies such as the use of selective pulmonary vasodilators and implantation of an LVAD have been able to successfully reduce pulmonary pressures in many candidates. 57,58 Therefore, patients with elevated pulmonary vascular resistance should undergo sequential therapy with prolonged continuous infusion of milrinone with or without pulmonary vasodilators, including sildenafil (4 to 8 weeks) with serial right heart catheterizations and uptitration of medications followed by mechanical device support if pulmonary hypertension is persistent. The algorithm used to address pulmonary hypertension is variable among transplant centers with no uniform consensus approach.…”

Current Options and Practices in Long-Term Ventricular Assist Devices

“…Further, patients ineligible for a heart transplant due to, what was previously considered, permanent end organ damage, such as fixed pulmonary hypertension, can experience recovery on LVAD support and subsequently undergo transplant. Such patients may experience similar transplant outcomes to those without the initial end organ damage [10]. This approach improves survival and quality of life for patients awaiting heart transplant while allowing better utilization of the limited number of donor hearts [11].…”