Left Ventricular Assist Devices or Inotropes for Decreasing Pulmonary Vascular Resistance in Patients with Pulmonary Hypertension Listed for Heart Transplantation

Al‐Kindi, Sadeer G.; Farhoud, Mahmoud; Zacharias, M.; Ginwalla, Mahazarin; ElAmm, Chantal; Benatti, Rodolfo; Oliveira, Guilherme H.

doi:10.1016/j.cardfail.2016.06.421

Cited by 35 publications

(19 citation statements)

References 22 publications

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“…Furthermore, LV unloading by implanting LV assist devices (LVAD) usually results in a substantial reduction of PAP in patients with severe HFrEF and even "fixed PH", without increasing the risk of post-procedural right heart failure [61][62][63]. Recent studies must be noted though, indicating that only about one-third of patients with fixed PH achieve normalization of PVR before transplant with either LVAD or inotropes [64], and decoupling of diastolic PAP and PAWP was identified as a prognostic factor after LVAD implantation [65].…”

Section: Commentsmentioning

confidence: 99%

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Rosenkranz

Lang

Blindt

et al. 2018

International Journal of Cardiology

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Section: Commentsmentioning

confidence: 99%

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Rosenkranz

Lang

Blindt

et al. 2018

International Journal of Cardiology

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“…An alternative—long‐term inotrope therapy—was examined by Al‐Kindi et al . in a retrospective analysis of patients with Group 2 PH in the United Network for Organ Sharing registry . There were similar rates of PH reversal in patients treated with LVAD and inotrope therapy prior to heart transplantation, highlighting the potential role of the latter therapy, as well as the need for individualized decision‐making in the absence of convincing evidence for one approach over the other.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous‐flow ventricular assist device therapy with intensive medical therapy in fixed pulmonary hypertension secondary to advanced left heart failure

et al. 2018

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AimsBoth ventricular assist device (VAD) and pulmonary vasodilator therapy have been shown in uncontrolled studies to improve pulmonary hypertension secondary to advanced left heart failure (Group 2 PH). This study aimed to compare haemodynamic benefits and survival in patients with fixed Group 2 PH treated with continuous‐flow VAD to intensive medical therapy.Methods and resultsNinety‐five patients listed for heart transplantation with sequential right heart catheters were studied, 24 patients having fixed Group 2 PH (as defined by cardiac index < 2.8 L/min/m2, pulmonary capillary wedge pressure > 15 mmHg, and transpulmonary gradient ≥ 15 mmHg or pulmonary vascular resistance > 3.0 WU, unresponsive to vasodilator challenge). Ten patients received VAD therapy, and 14 patients received standard heart failure therapy with or without sildenafil, nitrates, or endothelin receptor antagonists.At repeat right heart catheterization, patients treated with VAD therapy demonstrated significant improvement in both transpulmonary gradient (19 vs. 12 mmHg, P = 0.046) and pulmonary vascular resistance (6.5 vs. 2.9 WU, P = 0.003) compared with baseline, while those treated with medical therapy did not (20.9 vs. 20.3 mmHg and 6.5 vs. 6.4 WU, P = NS for both). Patients who received VAD therapy were significantly more likely to achieve normalized transpulmonary gradient (8/10 vs. 4/14, P = 0.013) and were more likely to be listed for orthotopic heart transplantation (7/10 vs. 4/14, P < 0.05). There were no significant differences between groups in terms of all‐cause mortality.ConclusionsContinuous‐flow VAD therapy more effectively reverses fixed Group 2 PH compared with medical therapy alone and may allow a higher rate of listing for orthotopic heart transplantation.

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“…While these findings are from a small, two-site cohort of patients implanted for clinical indications outside of clinical trials, they suggest that continued serial RHM for patients along a spectrum of PH-LHD is essential because many of these patients will proceed to end-stage HF and ultimately require more advanced therapies. 17,18 A better understanding of the progression of the haemodynamic profile of patients with worsening HF will likely become a crucial element for Pulmonary hypertension and pressure reduction identifying the optimal timing of advanced HF strategies such as durable mechanical circulatory support 19 or heart transplantation, especially among the high-risk Cpc-PH population. 17…”

Section: Discussionmentioning

confidence: 99%

Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor

et al. 2018

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AimsRemote haemodynamic monitoring (RHM) decreases hospitalization rates in patients with chronic heart failure (HF). Many patients with chronic HF develop pulmonary hypertension (PH) secondary to left heart disease with some acquiring combined pre‐capillary and post‐capillary PH (Cpc‐PH). The efficacy of RHM in achieving pulmonary pressure reductions in patients with Cpc‐PH vs. isolated post‐capillary PH (Ipc‐PH) is unknown. The purpose of this study is to evaluate whether a higher baseline diastolic pressure gradient (DPGbaseline) measured at the time of CardioMEMS™ HF sensor implantation is associated with lower reductions in pulmonary artery diastolic pressures (PADP).Methods and resultsThis was a retrospective analysis of 32 patients meeting clinical indications for CardioMEMS™ implantation. DPGbaseline categorized patients as Cpc‐PH (DPG ≥ 7 mmHg) or Ipc‐PH (DPG < 7 mmHg). Minimum achievable PADP (PADPmin) and ∆PADP (PADPbaseline − PADPmin) were determined. Pearson's correlation analysis and comparison of mean pressure changes were assessed. Median age was 69 years, and median left ventricular ejection fraction (LVEF) was 25%. Eight patients (25%) had a LVEF ≥40%. Twenty‐five patients (78%) met criteria for Ipc‐PH and seven (22%) for Cpc‐PH. Neither PADPmin (ρ = 0.27; P = 0.13) nor ΔPADP (ρ = 0.07; P = 0.72) was correlated with DPGbaseline. A trend towards higher ΔPADP was seen in Cpc‐PH vs. Ipc‐PH patients (15.2 vs. 9.88 mmHg; P = 0.12). There was a moderate positive correlation between baseline PADP and ΔPADP [ρ = 0.55 (0.26–0.76); P < 0.001].ConclusionsDecreased PADP reduction was not seen in Cpc‐PH vs. Ipc‐PH patients. Higher PADPbaseline was associated with greater ΔPADP. Larger studies are needed to elaborate our findings.

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Left Ventricular Assist Devices or Inotropes for Decreasing Pulmonary Vascular Resistance in Patients with Pulmonary Hypertension Listed for Heart Transplantation

Cited by 35 publications

References 22 publications

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Comparison of continuous‐flow ventricular assist device therapy with intensive medical therapy in fixed pulmonary hypertension secondary to advanced left heart failure

Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor

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