Triple Therapy for Persistent Pulmonary Hypertension Post Left Ventricular Assist Device: A Success Case for Cardiac Transplant

Abstract

Patients with end stage heart failure often develop pulmonary hypertension which resolves after placement of left ventricular assist device (LVAD). Some patients develop persistent pulmonary hypertension despite LVAD implantation. This excludes them from being able to receive a heart transplant. High pulmonary vascular resistance is associated with poor prognosis in patients with LVAD. There are no treatment guidelines available for long term treatment of pulmonary hypertension in LVAD patients in an ambulatory setting. We present a case of persistently high pulmonary vascular resistance in a patient with LVAD who qualified for heart transplant, after his pulmonary vascular resistance and pulmonary artery pressures were successfully reduced with combination of sildenafil, selexipag and macitentan. As to our knowledge, treatment of persistent pulmonary hypertension post LVAD with long-term selexipag has not been reported in the literature. Patients with persistent pulmonary hypertension despite LVAD implantation should be assessed and treated in the ambulatory setting with pulmonary vasodilator therapy to decrease mortality and aid in candidature for heart transplantation.