Document Detail


Reversal of secondary pulmonary hypertension by axial and pulsatile mechanical circulatory support.
MedLine Citation:
PMID:  19782604     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary hypertension associated with chronic congestive heart failure posses a significant risk of morbidity and death after heart transplantation. Isolated observations suggest that chronic ventricular unloading may lead to normalization of pulmonary pressures and thus render a patient likely to be a heart transplant candidate. METHODS: This study is a retrospective analysis of 9 heart failure patients with secondary pulmonary hypertension (transpulmonary gradient [TPG] > 15 mm/Hg). Two were treated with a pulsatile left ventricular assist device (LVAD) and 7 with an axial-flow LVAD. RESULTS: After LVAD support, mean pulmonary artery pressure decreased from 39 +/- 7 to 31 +/- 5 mm Hg, and the TPG decreased from 19 +/- 3 to 13 +/- 4 mm Hg (p < 0.01). The 1-year Kaplan-Meier survival curve for patients with pre-LVAD TPG > 15 mm Hg vs those with TPG < 15 mm Hg showed no difference in survival (p = 0.6). This finding was supported by analysis of a large multi-institutional cohort obtained from the Organ Procurement and Transplantation Network database, where no differences in survival were found in the same groups. CONCLUSIONS: Pulmonary hypertension that is secondary to congestive heart failure, as defined by a TPG > 15 mm Hg can be reversed by the use of pulsatile and axial-flow LVADs; furthermore, post-transplant survival for patients with secondary pulmonary hypertension treated with an LVAD was no different than for those without pulmonary hypertension who received LVAD support.
Authors:
Guillermo Torre-Amione; Robert E Southard; Matthias M Loebe; Keith A Youker; Brian Bruckner; Jerry D Estep; Megan Tierney; George P Noon
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2009-09-26
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  29     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-05-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  195-200     Citation Subset:  IM    
Affiliation:
The Department of Cardiology, The Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA. gtorres@tmhs.org <gtorres@tmhs.org>
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Heart Failure / complications,  mortality,  surgery*
Heart-Assist Devices*
Hemodynamics
Humans
Hypertension, Pulmonary / complications,  mortality,  surgery*
Male
Middle Aged
Retrospective Studies
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
231-00-0115//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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