• J. Thorac. Cardiovasc. Surg. · Nov 2015

    Effect of pulmonary vascular resistance before left ventricular assist device implantation on short- and long-term post-transplant survival.

    • Masaki Tsukashita, Hiroo Takayama, Koji Takeda, Jiho Han, Paolo C Colombo, Melana Yuzefpolskaya, Veli K Topkara, Arthur Reshad Garan, Donna M Mancini, Paul A Kurlansky, and Yoshifumi Naka.
    • Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physician and Surgeons, New York, NY. Electronic address: mt2993@cumc.columbia.edu.
    • J. Thorac. Cardiovasc. Surg. 2015 Nov 1;150(5):1352-60, 1361.e1-2.

    ObjectivesPulmonary hypertension is often considered a contraindication to orthotopic heart transplantation. Left ventricular assist device support may improve pulmonary hypertension by unloading the left ventricle, making patients eligible for transplantation. We sought to investigate the effect of continuous-flow left ventricular assist device support on pulmonary hypertension and compare post-transplantation outcomes in patients with preexisting pulmonary hypertension.MethodsBetween March 2004 and December 2013, 256 potential orthotopic heart transplantation candidates underwent continuous-flow left ventricular assist device implantation at Columbia University. Preimplantation right heart catheterization data were available for 227 patients. Patients were divided into 2 groups on the basis of preimplantation pulmonary vascular resistance: low (<5 Wood units) (n = 182) and high (≥5 Wood units) (n = 45). Postimplantation and post-transplantation outcomes were compared between the groups.ResultsPulmonary vascular resistance in the high resistance group decreased significantly during left ventricular assist device support (P < .001). Post-transplantation in-hospital mortality was significantly higher in patients with high vascular resistance (P < .05). However, 3-year survival after transplantation was similar between groups (85.0% and 79.0% for low and high vascular resistance, respectively; P = .45).ConclusionsContinuous-flow left ventricular assist device therapy reduced pulmonary vascular resistance. Subsequent orthotopic heart transplantation in patients with significantly elevated pulmonary vascular resistance resulted in higher in-hospital mortality but similar 3-year survival.Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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