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Eur J Cardiothorac Surg 2007;31:698-702. doi:10.1016/j.ejcts.2006.12.036
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Post-transplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices

^a Department of Cardiothoracic Surgery, Medical University of Vienna, Wahringer Guertel 18-20, A-1090 Vienna, Austria
^b Department. of Biomedical Engineering, Medical University of Vienna, Ludwig Bolzman Institute for Cardiovascular Research, Austria

Received 26 September 2006; received in revised form 17 December 2006; accepted 18 December 2006.

^_* Corresponding author. Tel.: +43 1 40400 5620; fax: +43 1 40400 5640. (Email: daniel.zimpfer{at}meduniwien.ac.at).

Objective: We have previously shown that fixed pulmonary hypertension in cardiac transplant candidates can be lowered using left ventricular assist devices (LVADs). The post-transplant survival of these patients is uncertain as pulmonary hypertension may reappear, possibly affecting post-transplant survival. Materials and methods: Between 01/2000 and 01/2005 a total of 26 cardiac transplant candidates (92% male; mean age 56.2 years) in whom fixed pulmonary hypertension was lowered by LVAD implantation (pulmonary vascular resistance (PVR) before implantation: 5.1 ± 2.8 wood units (WU); PVR before cardiac transplantation: 2.0 ± .9 WU) underwent cardiac transplantation at our institution. These patients were age and sex matched with 52 cardiac transplant candidates without pulmonary hypertension undergoing cardiac transplantation during the same time period. Study endpoints were peri-transplant complications and long-term survival. Mean follow-up was 36 ± 14 months. Results: Peri-transplant mortality was 5% in patients after LVAD therapy and 7% in patients without prior LVAD therapy (p = .089). We observed 2 cases (4%) of acute right heart failure requiring mechanical support in patients without prior LVAD therapy. None of the patients with LVAD therapy developed peri-transplant right heart failure requiring mechanical support. Incidence of other peri-transplant complications was comparable between the two groups. Log-rank (p = .124) revealed comparable long-term survival between patients with (1 year: 85%, 2 year: 85%, 3 year: 85%) and without (1 year: 90%, 2 year 82%, 3 year prior 79%) prior LVAD therapy. Conclusion: LVAD therapy lowers fixed pulmonary hypertension in cardiac transplant candidates with fixed pulmonary hypertension. Thereafter, long-term post-transplant survival is comparable to cardiac transplant recipients without pulmonary hypertension.

Key Words: Heart disease • Heart failure • Heart assist devices • Pulmonary hypertension • Transplantation

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