Monitoring pulmonary pressures during long‐term continuous‐flow left ventricular assist device and fixed pulmonary hypertension: redefining alleged pathophysiological mechanisms?

Abstract

Pulmonary hypertension (PH) type II (classified by the World Health Organization) is a common complication in chronic leftsided heart failure. In advanced heart failure therapy, fixed PH is an absolute contraindication for heart transplantation after which a left ventricular assist device (LVAD) is the only remaining option. With remote monitoring, we can now continuously evaluate the pulmonary artery pressures during long-term LV unloading by the LVAD. In this case, we demonstrate that fixed PH can be reversed with LVAD implantation, whereby previous thoughts of this concept should be redefined in the era of assist devices.

Safety and feasibility of hemodynamic pulmonary artery pressure monitoring using the CardioMEMS device in LVAD management

“…The median age was 60 (53-66) years, and 87% of patients were men. The median RA pressure was 5.0 [2.3-9.8], and the median systolic, diastolic, and mean PAP were 35 (28-46), 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), and 24 (21-32) mmHg, respectively, at baseline.…”

“…Many patients with irreversible pulmonary hypertension (not responsive to vasodilators) receive LVAD therapy as destination therapy. Still, several reports 20 also show that with several months to up to a year of continuous LV unloading, some patients do reverse PAP and become eligible for heart transplantation. Additionally, patients on the waiting list for heart transplantation with borderline pulmonary hypertension or rising PAP need to be studied with Swan Ganz measurements every 6 months 21 .…”