Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2018 Dec 1;54(6):1116-1121. doi: 10.1093/ejcts/ezy214.
Fixed pulmonary hypertension (fPH) is a contraindication for heart transplantation (HTX). Left ventricular assist device (LVAD) implantation as a bridge to candidacy can reverse fPH in patients with terminal heart failure by chronic left ventricular unloading. We report our institutional experience with terminal heart failure patients and fPH that were successfully bridged to candidacy and underwent subsequent HTX.
We retrospectively reviewed the data of 79 patients with terminal heart failure and fPH who were successfully bridged to candidacy for HTX with 6 different LVAD devices at our centre from October 1998 to September 2016 (Novacor n = 4, MicroMed DeBakey n = 29, DuraHeart n = 2, HeartMate II n = 14, HVAD n = 29 and MVAD n = 1). Median duration of LVAD support was 288 days (range 45-2279 days). Within the same timeframe, a control group of 48 patients underwent HTX after bridge-to-transplant LVAD therapy for reasons other than PH. Study end points were (i) development of fPH after LVAD implantation, (ii) post-transplant outcomes and (iii) incidence of severe adverse events.
Pulmonary vascular resistance, assessed by vasodynamic catheterization, was 4.3 ± 1.8 WU before LVAD implantation. After a median support period of 89 days (interquartile range 4-156 days), pulmonary vascular resistance decreased to 2.0 ± 0.9 WU (P ≤ 0.001), and patients were listed for HTX. Median duration of LVAD support in the study group was 288 days (45-2279 days). We observed 2 patients (2.5%) with acute right heart failure who required extracorporeal mechanical support after HTX in the study group. Long-term post-transplant survival between the study group (3 years: 83.5%, 5 years: 81.0%) and the control group (3 years: 87.5%, 5 years: 85.4%) was comparable (log-rank: P = 0.585).
LVAD implantation as a bridge to candidacy reverses fPH in patients with terminal heart failure. Post-HTX survival is excellent and comparable to results obtained in patients without fPH at the time of HTX listing.
固定性肺动脉高压（fPH）是心脏移植（HTX）的禁忌证。通过慢性左心室卸载，左心室辅助装置（LVAD）作为候选者的桥接可以逆转终末期心力衰竭患者的 fPH。我们报告了我们机构在终末期心力衰竭和 fPH 患者中的经验，这些患者通过 6 种不同的 LVAD 设备成功桥接候选者，并随后接受 HTX。
我们回顾性分析了 1998 年 10 月至 2016 年 9 月期间，我们中心使用 6 种不同的 LVAD 设备成功桥接候选者进行 HTX 的 79 例终末期心力衰竭和 fPH 患者的数据（Novacor n=4，MicroMed DeBakey n=29，DuraHeart n=2，HeartMate II n=14，HVAD n=29，MVAD n=1）。LVAD 支持的中位时间为 288 天（范围 45-2279 天）。在同一时间段内，48 例患者因 PH 以外的原因接受了桥接 LVAD 治疗后的 HTX，作为对照组。研究终点为：（i）LVAD 植入后 fPH 的发生，（ii）移植后结局和（iii）严重不良事件的发生率。
LVAD 植入前通过血流动力学导管评估肺动脉阻力为 4.3±1.8 WU。中位支持期 89 天后（四分位距 4-156 天），肺动脉阻力降至 2.0±0.9 WU（P≤0.001），并将患者列入 HTX 名单。研究组 LVAD 支持的中位时间为 288 天（45-2279 天）。我们观察到 2 例（2.5%）研究组患者在 HTX 后发生急性右心衰竭，需要体外机械支持。研究组与对照组（3 年：83.5%，5 年：81.0%）的长期移植后生存率相当（对数秩：P=0.585）。
LVAD 植入作为候选者的桥接可逆转终末期心力衰竭患者的 fPH。HTX 后生存率优异，与 HTX 时无 fPH 患者的结果相当。
