Favorable Effects on Pulmonary Vascular Hemodynamics with Continuous-Flow Left Ventricular Assist Devices Are Sustained 5 Years After Heart Transplantation

Abstract

It is unclear whether pulmonary hemodynamics improvement with left ventricle unloading with left ventricular assist devices (LVADs) is sustained long term after heart transplant (HT). We sought to assess the effects on pulmonary vascular hemodynamics during continuous-flow (CF-LVAD) and pulsatile flow (PF-LVAD) support up to 5 years after HT. Invasive hemodynamics were evaluated before LVAD, before HT, and at 3 months, 1, and 3-5 years posttransplant. Thirty-eight patients were included in the study and divided into two groups according to the type of LVAD support. The two groups were well matched in age and gender. Mean pulmonary artery pressure (PAPm) and systolic PAP (PAPs) improved significantly in the PF-LVAD group (40 ± 10.6 to 19.8 ± 4.4 mm Hg and 62.7 ± 14.9 to 31.8 ± 5.9 mm Hg, respectively) and in the CF-LVAD group (37.4 ± 11.6 to 22.4 ± 7.7 mm Hg and 53.7 ± 18.0 to 34.6 ± 11.8 mm Hg, respectively). Reductions in PAPm and PAPs were more pronounced in PF-LVAD group than in CF-LVAD group (p = 0.005 and p = 0.03, respectively). After HT, the improvement in PAPm and PAPs was sustained after 3-5 years in patients who received PF-LVAD (22.6 ± 6.5 and 32.2 ± 9.2 mm Hg, respectively) and in patients who received CF-LVAD (22.2 ± 8.4 and 33.8 ± 9.6 mm Hg, respectively). In conclusion, long-term LVAD support resulted in significant improvement in PAPm and PAPs regardless of the pump generation. The improvement in hemodynamics observed during LVAD support was sustained 3-5 years posttransplant.

Changes in pulmonary artery pressure before and after left ventricular assist device implantation in patients utilizing remote haemodynamic monitoring

“…Specifically, frequent monitoring of PA pressures has been shown to significantly reduce long-term HF hospitalization rates as shown in both the CHAMPION [CardioMEMS™ Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association Functional Class III Heart Failure Patients] clinical trial and in real-world experience. [9][10][11] Implantation of LVAD in patients previously implanted with a PA pressure sensor gives us an opportunity to describe longitudinal haemodynamic trends in LVAD patients. LVADs have been an increasingly utilized therapy for those with advanced HF and have resulted in improvements in patient functional status and quality of life, in addition to improved clinical outcomes relative to medical therapy.…”

“…[6][7][8] While it is known that PA pressures decrease after both pulsatile and continuous flow LVAD implants, the magnitude, time course, and longterm sustainability of PA pressure changes is not well understood. [9][10][11] Implantation of LVAD in patients previously implanted with a PA pressure sensor gives us an opportunity to describe longitudinal haemodynamic trends in LVAD patients. Therefore, in this manuscript, we set out to characterize haemodynamic changes in the period leading up to LVAD implant and long-term follow-up thereafter.…”

Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation

“…Left ventricular assist device treatment has been demonstrated to reduce mPAP and sPAP with sustained effect three to 5 years following OHT. 22 Moreover, in a small study, LVAD support has been shown to progressively increase CO and decrease PAWP in the early period following LVAD implantation. Furthermore, markers of RV adaptation (i.e.…”

Computational analysis of the hemodynamic characteristics under interaction influence of β-blocker and LVAD

“…Long-term LVAD support resulted in significant improvement in pulmonary artery pressure regardless of the pump generation. The improvement in hemodynamics observed during LVAD support was sustained 3–5 years posttransplant [ 56 ]. In addition, recurrence rate of cardiac function deterioration among patients with LVAD explantation is 52% in 1 year and 80% in 3 years.…”