Normalization of high pulmonary vascular resistance with LVAD support in heart transplantation candidates☆

Abstract

Elevated PVR and severe PH were both previously considered as contraindication for heart transplantation. A period of LVAD pumping leads to a progressive decrease of PVR and normalization of pulmonary pressures, making these patients amenable for heart transplantation. LVAD as bridge to heart transplantation is safe and highly beneficial for terminal heart failure patients with severe PH.

Indications for Heart Transplantation in Pediatric Heart Disease

“…194 Furthermore, utilization of ventricular assist devices for mechanical circulatory support has been associated with normalization of high pulmonary vascular resistance in adult patients. 195,196 As experience in mechanical ventricular assist devices increases in pediatric heart failure, 197,198 their use and the use of pulmonary vasodilators will likely redefine what truly constitutes fixed, irreversible elevation of pulmonary vascular resistance that would preclude orthotopic heart transplantation in pediatric heart disease.…”

Valvular Heart Disease in Patients Supported With Left Ventricular Assist Devices

“…In theory, either lesion might limit net flow across the pulmonary vasculature, thus delaying reduction of RV afterload and contributing to RV failure. This may be less clinically relevant given the ability of LVAD therapy to lower pulmonary pressures, 34 thereby generating a pressure gradient favoring antegrade flow across the pulmonic valve. Therefore, pulmonic valve pathology may have minimal untoward consequences and is unlikely to be a frequent site of intervention.…”

Role of Implantable Cardioverter-Defibrillators in Patients With Continuous Flow Ventricular Assist Devices

“…[10][11][12][13] The reason for tolerance of ventricular fibrillation with LVAD support in these cases likely relates to the marked reduction in pulmonary vascular resistance, which is evident in patient with chronic LVAD support. 14,15 This allows for the creation of a Fontan-like circulation where even severely depressed or absent right ventricular function, which may occur in the setting of rapid ventricular tachycardia or ventricular fibrillation, can be tolerated without the development of cardiovascular collapse. 13 In this context, the second important finding reported in this article, that an active ICD does not confer an additional survival advantage after implantation of an LVAD, makes intuitive sense.…”