Background: Continuous flow left ventricular assist devices (LVADs) have a positive effect on pulmonary hypertension (PH) that is critical for patients implanted as bridge to heart transplant (BTT). Routine right heart catheterization (RHC) for evaluation of PH is frequently done after LVAD implant. We describe the role of RHC in treatment of PH in patients with an LVAD as BTT.
Methods: We performed a retrospective analysis of treatment of PH based on results of RHC in patients with isolated LVAD for more than 6 months. Thirty eight patients implanted with LVAD as BTT from 2008-2012 were included. Of those, 24 patients (63%) had a pulmonary vascular resistance (PVR) >2.5 at time of implant (Group A), and 14 patients (37%) had PVR<2.5 (Group B). Baseline characteristics were comparable between groups.
Results: Average duration of support was 20.5±9.1 and 21.5±10.6 months for Group A and B, respectively (NS). Mean PVR for Group A and B are presented in table 1. Five patients in group A required treatment of PH, by addition or up-titration of PDE-5 inhibitor, as a result of routine RHC, compared to none in Group B. There were no major complications with RHC.
Conclusions: There was no need for treatment of PH in patients with normal PVR at LVAD implant. None of the patients with PVR < 2.5 at implant had elevation of PVR after implant. In patients with PVR above 2.5 pre-implant, no intervention was done for PH after PVR was <2.5. There seems to be no need for routine RHC for asymptomatic patients with normal PVR, after LVAD implant.
