Comparison of Continuous‐Flow and Pulsatile‐Flow Blood Pumps on Reducing Pulmonary Artery Pressure in Patients With Fixed Pulmonary Hypertension

Abstract

Pulmonary hypertension (PH) is considered as a risk factor for morbidity and mortality in patients undergoing heart transplantation. Recently, left ventricular assist device (LVAD) implantation has been increasingly used in reducing pulmonary artery pressure (PAP) in patients with PH unresponsive to medical therapy. Herein, we aimed to compare the efficacy of continuous-flow and pulsatile-flow blood pumps on the improvement of PH in mechanical circulatory support patients. Twenty-seven patients with end-stage heart failure who underwent LVAD implantation surgery were enrolled. Fifteen of them (55.6%) had continuous-flow pump (HeartWare Ventricular Assist System, HeartWare, Inc., Miramar, FL, USA), and 12 of them (44.4%) had pulsatile pump (Berlin Heart EXCOR ventricular assist device, Berlin Heart AG, Berlin, Germany). The efficacy of LVADs on the improvement of PH was compared between continuous-flow and pulsatile pumps by the evaluation of systolic PAP, tricuspid annular plane systolic excursion (TAPSE), right ventricular systolic motion (RVSM), right ventricular ejection fraction (RVEF), and grade of tricuspid insufficiency (TI) for each of the study participants. All of the 15 patients who underwent continuous-flow blood pump implantation surgery (Group 1) were male with a mean age of 46.9 ± 11.7 years, and in pulsatile-flow blood pump implanted participants (Group 2), the mean age was 40.6 ± 16.8 years, all of whom were also male (P=0.259). Mean follow-up was 313.7 ± 241.3 days in Group 1 and 448.7 ± 120.7 days in Group 2 (P=0.139). In Group 1, mean preoperative and postoperative systolic PAP were measured as 51.7 ± 12.2 mm Hg and 22.2 ± 3.4 mm Hg, respectively, while those in Group 2 were 54.5 ± 7.5 mm Hg and 33.9 ± 6.4 mm Hg, respectively. A significantly greater decrease in systolic PAP was noticed in patients with continuous-flow blood pumps (P=0.023); however, no statistically significant difference was found when we considered the change in TAPSE between study groups (P=0.112). A statistical significance in the alteration of RVEF, RVSM, and the grade of TI during study visits was not found between the study groups (P=0.472, P=0.887, and P=0.237, respectively). Although the two studied types of LVADs were found to be effective in reducing PAP in heart transplantation candidates with PH, lesser postoperative systolic PAP values were achieved in patients who underwent continuous-flow pump implantation surgery.

İleri evre kalp yetersizliği rehberi

“…Sol kalp hastalığına bağlı ciddi pulmoner hipertansiyonu olan olgularda uzun süreli destek cihazı uygulaması ile sol ventrikülün basınçlarının azaldığı, pulmoner basıncın düştüğü ve bu hastaların kalp nakline uygun hale geldiği çalışmalarda gösterilmiştir. [283][284][285] …”

Left ventricular assist devices in end-stage heart failure with “fixed” pulmonary hypertension-a test of reversibility?

“…No significant differences were noted in right ventricular systolic motion, tricuspid annular plane systolic excursion, and right ventricular ejection fraction. 4 In another single center prospective study, 29 patients with centrifugal pumps had significant improvement in their transpulmonary gradients, pulmonary artery systolic pressures, mean pulmonary artery pressures, and pulmonary vascular resistance. These differences developed within one month post implantation.…”

“…1 Fixed PH (>2.5 Wood units) is an absolute contraindication to cardiac transplantation due to its detrimental effects on the right ventricular function. [2][3][4][5] When pharmacological agents fail to decrease left ventricular filling pressures chronically, mechanical unloading becomes necessary to reverse the PH due to left heart disease. Unloading the left ventricle with a left ventricular assist device (LVAD) progressively decreases pulmonary vascular resistance to normal values in patients making them eligible for heart transplantation.…”

“…4 In a small single center study of 27 LVAD patients (15 with CF pumps [Heart Ware Inc., Framingham, MA] and 12 with pulsatile pumps [Berlin Heart EXCOR, Berlin, Germany]), the patients with CF pumps had greater reductions in pulmonary artery systolic pressures. No significant differences were noted in right ventricular systolic motion, tricuspid annular plane systolic excursion, and right ventricular ejection fraction.…”

“…4 These small studies require validation with randomized clinical trials to establish scientific proof.…”