Cor Vasa 2011, 53(1-2):48-54

Left ventricular assist devices for treatment of severe pulmonary hypertension in orthotopic heart transplantation candidates at IKEM

Zora Dorazilová^1,*, Jiří Kettner¹, Ivan Netuka², Markéta Hegarová¹, Ivo Skalský², Hynek Říha³, Hikmet Al-Hiti¹, Josef Kautzner¹, Jan Pirk²

¹ Klinika kardiologie

² Klinika kardiovaskulární chirurgie

³ Klinika anesteziologie a resuscitace, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction: Until recently, severe pulmonary hypertension (PH) has been a contraindication for patients at risk of acute right ventricular failure of the donor graft and its possible loss in the immediate post-transplant period.

Aim: The aim of our study was to assess the efficacy of the HeartMate II LVAD (left ventricular assist device) (Thoratec Corp., Pleasanton, CA, USA) in modulating PH thereby allowing to safely perform orthotopic heart transplantation.

Patients and methods: From October 2008 through September 2010, 36 patients with end-stage chronic heart failure had HeartMate II LVAD implantation at the Institute for Clinical and Experimental Medicine. Of this number, nine (25%) had severe, pharmacologically irreversible PH. Right-heart catheterization was undertaken in all patients prior to LVAD implantation. Eight patients (six males) had their follow-up right-heart pressure measured, including cardiac output determination by thermodilution, at 32 to 112 days after LVAD implantation. Three patients had additional follow-up right-heart catheterization between days 11 and 21 after successful orthotopic heart transplantation.

Results: Follow-up hemodynamic assessment after LVAD implantation revealed a significant decrease in pulmonary vessel bed pressures compared with pre-implant values. Mean pulmonary artery pressure (MPAP) decreased from an average pre-implant value of 50±7 mmHg to 22±6 mmHg; a decrease in the mean transpulmonary gradient from 21±6 mmHg to 11±4 mmHg and an increase in mean cardiac output from 3.5±0.7 to 4.4±1 l/min resulted in a decrease in calculated mean pulmonary vascular resistance from 6.2±1.5 Wood units to an acceptable 2.7±0.8 Wood units (p

Keywords: Orthotopic heart transplantation; Pulmonary hypertension; Left ventricular assist devices; HeartMate II LVAD

Published: January 1, 2011  Show citation