Anegawa Eiji, Seguchi Osamu, Mochizuki Hiroki, Kuroda Kensuke, Doi Nakajima Seiko, Watanabe Takuya, Yanase Masanobu, Tadokoro Naoki, Fukushima Satsuki, Fujita Tomoyuki, Fukushima Norihide
From the Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan.
ASAIO J. 2023 Feb 1;69(2):151-158. doi: 10.1097/MAT.0000000000001739. Epub 2022 Apr 13.
Prevalence of combined pre- and post-capillary (Cpc) pulmonary hypertension (PH) in patients with PH due to left heart disease (PH-LHD) and the long-term impact of left ventricular assist device (LVAD) implantation in patients with Cpc-PH are not fully elucidated. Eighty-nine patients with PH-LHD who underwent LVAD implantation were retrospectively analyzed. Patients were divided into two groups according to their preoperative pulmonary vascular resistance (PVR) and diastolic pressure gradient (DPG) values (Cpc-PH group, PVR >3 wood units [WU], or DPG ≥7 mmHg; isolated postcapillary [Ipc]-PH group, PVR ≤3 WU, and DPG <7 mmHg). There were 50 patients with Cpc-PH (PVR >3 WU [group A, n = 41]; PVR >3 WU and DPG ≥7 mmHg [group B, n = 8]; DPG ≥7 mmHg [group C, n = 1]), and 39 patients with Ipc-PH. Despite a successful LVAD implantation in all participants, 13 and two patients remained in groups A and B, respectively, early after LVAD implantation, whereas two patients each remained in groups A and B 1 year postoperatively. Values of PVR and DPG in the Cpc-PH group returned to normal levels by 3 years postoperatively. Over 50% of patients with PH-LHD had Cpc-PH, and PVR and DPG normalized in all participants within 3 years after LVAD implantation.
左心疾病（PH-LHD）所致肺动脉高压（PH）患者中毛细血管前和毛细血管后合并性肺动脉高压（Cpc-PH）的患病率以及左心室辅助装置（LVAD）植入对Cpc-PH患者的长期影响尚未完全阐明。对89例行LVAD植入的PH-LHD患者进行回顾性分析。根据术前肺血管阻力（PVR）和舒张压梯度（DPG）值将患者分为两组（Cpc-PH组，PVR>3伍德单位[WU]，或DPG≥7 mmHg；单纯毛细血管后[Ipc]-PH组，PVR≤3 WU且DPG<7 mmHg）。有50例Cpc-PH患者（PVR>3 WU[ A组，n = 41]；PVR>3 WU且DPG≥7 mmHg[ B组，n = 8]；DPG≥7 mmHg[ C组，n = 1]），39例Ipc-PH患者。尽管所有参与者LVAD植入均成功，但LVAD植入后早期A组和B组分别有13例和2例患者病情未改善，而术后1年A组和B组各有2例患者病情未改善。Cpc-PH组的PVR和DPG值在术后3年恢复至正常水平。超过50%的PH-LHD患者患有Cpc-PH，且LVAD植入后3年内所有参与者的PVR和DPG均恢复正常。
