Left Ventricular Assist Devices in Pulmonary Hypertension Group 2 With Significantly Elevated Pulmonary Vascular Resistance: A Bridge to Cure

Ahmed M. Selim, Lalit Wadhwani, Adam Burdorf, Eugenia Raichlin, Brian D Lowes, Ronald Zolty

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Pulmonary hypertension secondary to left heart disease (WHO Group 2)is a known risk factor in patients with heart failure. The favourable effect of left ventricular assist devices (LVAD)on pulmonary hypertension has been demonstrated before, although this effect has not been well-studied in advanced pulmonary arterial bed disease with a significant elevation in pulmonary vascular resistance. Methods: We reviewed the records of 258 LVAD patients in our institution. Patients with elevated mean pulmonary artery pressure (mPAP > 25 mmHg)and elevated pulmonary vascular resistance (PVR ≥3 Wood units)were included in the study. Patients were divided into two groups based on their baseline PVR (PVR = 3–5 Wood units (WU)vs. PVR > 5 WU). The groups were studied for the changes in their pulmonary haemodynamics after the placement of LVAD. Results: Fifty-one (51)patients were included in the study. All patients showed a significant improvement in their pulmonary haemodynamic parameters post LVAD placement. In the group with the higher PVR, mPAP dropped from a baseline of 43 ± 7 mmHg to 22 ± 6 mmHg post LVAD placement (p < 0.001), while PVR dropped from 6.3 ± 1.2 Wood units to 2.2 ± 1.1 Wood units (p < 0.001). In a subgroup of patients who underwent cardiac transplantation post LVAD (n = 14), all patients maintained a normalised PVR (<3WU)one year post cardiac transplantation. Conclusions: Left ventricular assist devices can reverse pulmonary hypertension WHO Group 2 with significantly elevated PVR; this effect is not dependent on the baseline PVR, and is maintained up to one year post cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)946-952
Number of pages7
JournalHeart Lung and Circulation
Volume28
Issue number6
DOIs
StatePublished - Jun 2019

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Heart-Assist Devices
Pulmonary Hypertension
Vascular Resistance
Heart Transplantation
Lung
Hemodynamics
Pulmonary Artery
Heart Diseases
Heart Failure
Pressure

Keywords

  • High PVR
  • LVAD
  • Pulmonary hypertension
  • WHO group 2

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Left Ventricular Assist Devices in Pulmonary Hypertension Group 2 With Significantly Elevated Pulmonary Vascular Resistance : A Bridge to Cure. / Selim, Ahmed M.; Wadhwani, Lalit; Burdorf, Adam; Raichlin, Eugenia; Lowes, Brian D; Zolty, Ronald.

In: Heart Lung and Circulation, Vol. 28, No. 6, 06.2019, p. 946-952.

Research output: Contribution to journalArticle

Selim, Ahmed M. ; Wadhwani, Lalit ; Burdorf, Adam ; Raichlin, Eugenia ; Lowes, Brian D ; Zolty, Ronald. / Left Ventricular Assist Devices in Pulmonary Hypertension Group 2 With Significantly Elevated Pulmonary Vascular Resistance : A Bridge to Cure. In: Heart Lung and Circulation. 2019 ; Vol. 28, No. 6. pp. 946-952.
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abstract = "Background: Pulmonary hypertension secondary to left heart disease (WHO Group 2)is a known risk factor in patients with heart failure. The favourable effect of left ventricular assist devices (LVAD)on pulmonary hypertension has been demonstrated before, although this effect has not been well-studied in advanced pulmonary arterial bed disease with a significant elevation in pulmonary vascular resistance. Methods: We reviewed the records of 258 LVAD patients in our institution. Patients with elevated mean pulmonary artery pressure (mPAP > 25 mmHg)and elevated pulmonary vascular resistance (PVR ≥3 Wood units)were included in the study. Patients were divided into two groups based on their baseline PVR (PVR = 3–5 Wood units (WU)vs. PVR > 5 WU). The groups were studied for the changes in their pulmonary haemodynamics after the placement of LVAD. Results: Fifty-one (51)patients were included in the study. All patients showed a significant improvement in their pulmonary haemodynamic parameters post LVAD placement. In the group with the higher PVR, mPAP dropped from a baseline of 43 ± 7 mmHg to 22 ± 6 mmHg post LVAD placement (p < 0.001), while PVR dropped from 6.3 ± 1.2 Wood units to 2.2 ± 1.1 Wood units (p < 0.001). In a subgroup of patients who underwent cardiac transplantation post LVAD (n = 14), all patients maintained a normalised PVR (<3WU)one year post cardiac transplantation. Conclusions: Left ventricular assist devices can reverse pulmonary hypertension WHO Group 2 with significantly elevated PVR; this effect is not dependent on the baseline PVR, and is maintained up to one year post cardiac transplantation.",
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AB - Background: Pulmonary hypertension secondary to left heart disease (WHO Group 2)is a known risk factor in patients with heart failure. The favourable effect of left ventricular assist devices (LVAD)on pulmonary hypertension has been demonstrated before, although this effect has not been well-studied in advanced pulmonary arterial bed disease with a significant elevation in pulmonary vascular resistance. Methods: We reviewed the records of 258 LVAD patients in our institution. Patients with elevated mean pulmonary artery pressure (mPAP > 25 mmHg)and elevated pulmonary vascular resistance (PVR ≥3 Wood units)were included in the study. Patients were divided into two groups based on their baseline PVR (PVR = 3–5 Wood units (WU)vs. PVR > 5 WU). The groups were studied for the changes in their pulmonary haemodynamics after the placement of LVAD. Results: Fifty-one (51)patients were included in the study. All patients showed a significant improvement in their pulmonary haemodynamic parameters post LVAD placement. In the group with the higher PVR, mPAP dropped from a baseline of 43 ± 7 mmHg to 22 ± 6 mmHg post LVAD placement (p < 0.001), while PVR dropped from 6.3 ± 1.2 Wood units to 2.2 ± 1.1 Wood units (p < 0.001). In a subgroup of patients who underwent cardiac transplantation post LVAD (n = 14), all patients maintained a normalised PVR (<3WU)one year post cardiac transplantation. Conclusions: Left ventricular assist devices can reverse pulmonary hypertension WHO Group 2 with significantly elevated PVR; this effect is not dependent on the baseline PVR, and is maintained up to one year post cardiac transplantation.

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