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Pulmonary Vascular Reverse Remodeling After Left Ventricular Assist Device Implantation in Patients With Pulmonary Hypertension. ASAIO J 2023; 69:151-158. [PMID: 36716069 DOI: 10.1097/mat.0000000000001739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
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.
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Ishihara S, Kioka H, Ohtani T, Asano Y, Yamaguchi O, Hikoso S, Toda K, Saito Y, Sawa Y, Yamauchi-Takihara K, Sakata Y. Successful treatment of severe combined post- and pre-capillary pulmonary hypertension in a patient with idiopathic restrictive cardiomyopathy. Pulm Circ 2018; 8:2045894018770131. [PMID: 29575985 PMCID: PMC5900822 DOI: 10.1177/2045894018770131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare form of cardiomyopathy that is characterized by restrictive ventricular filling. Elevated filling pressure leads to pulmonary hypertension (PH), which often progresses to combined post- and pre-capillary PH (Cpc-PH) with increased diastolic pulmonary vascular pressure gradient (DPG) and pulmonary vascular resistance (PVR) caused by longstanding backward hemodynamic consequences of left heart disease (LHD) leading to morphological changes in the pulmonary vasculature. Patients with high PVR undergoing left ventricular assist device (LVAD) implantation are at increased risk of postoperative right-sided heart failure requiring concomitant implantation of a right ventricular assist device (RVAD). We report a case of RCM with severe Cpc-PH due to extremely elevated DPG and PVR. The patient presented recurrent syncope caused by severe PH. Right heart catheterization (RHC) revealed highly elevated DPG 30 mmHg and PVR 25.3 Wood units (WU) and subsequent significant reduction of right ventricular afterload during vasoreactivity testing with inhaled nitric oxide (NO) to DPG 5 mmHg and PVR 10.5 WU. During the administration of pulmonary vasodilators, pulmonary congestion worsened. Second RHC revealed elevated pulmonary arterial wedge pressure (PAWP) and modest decrease of pulmonary arterial pressure (PAP) 87 mmHg and PVR 9.6 WU. Therefore, an inotropic agent and systemic vasodilator were added for the treatment of left-sided heart failure. Targeting elevated filling pressures with both PAH-specific and heart failure treatment, a further decrease of right ventricular afterload with DPG of 5 mmHg and PVR of 3.8 WU was achieved. In a next step, LVAD was successfully implanted, without need for RVAD, as a bridge to transplantation. This is the first reported case of Cpc-PH that revealed the potential reversibility of extremely elevated DPG and PVR, and suggests the importance of preoperative RHC-guided optimized medical PAH-specific and heart failure treatment before LVAD implantation.
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Affiliation(s)
- Satomi Ishihara
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,2 First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hidetaka Kioka
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomohito Ohtani
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Asano
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osamu Yamaguchi
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shungo Hikoso
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- 3 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiko Saito
- 2 First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshiki Sawa
- 3 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keiko Yamauchi-Takihara
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,4 Health and Counseling Center, Osaka University, Toyonaka, Osaka, Japan
| | - Yasushi Sakata
- 1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Bejko J, Pittarello D, Falasco G, Di Gregorio G, Tarzia V, Rizzoli G, Gregori D, Gerosa G, Bottio T. A pilot study on the efficacy and safety of a minimally invasive surgical and anesthetic approach for ventricular assist device implantation. Int J Artif Organs 2017; 41:0. [PMID: 29048703 DOI: 10.5301/ijao.5000647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of our study was to compare 2 surgical and anesthetic approaches during ventricular assist device implantation. METHODS 68 patients (50.4 ± 17.1 years old) were supported with the HeartWare® HVAD (32 patients) and the Jarvik 2000 VAD (36 patients) between January 2010 and August 2016. Two surgical techniques were applied: a minimally invasive approach with the aid of paravertebral-block (mini-invasive group, 41 patients) and a standard-surgical-approach with the aid of general anesthesia (27 patients). RESULTS The minimally invasive approach allowed faster postoperative recovery by significantly reducing the duration of surgery (p<0.05), anesthesia (p<0.05), mechanical ventilation (p<0.05), inotropic support (p<0.05), ICU and in-hospital stay (p<0.05), and time to first mobilization (p<0.05). No case of epidural hematoma was observed. Eleven patients died (16%) at 30 days, 3 in the mini-invasive group (7.3%) and 8 in the invasive group (29.6%). CONCLUSIONS Minimally invasive approaches play a substantial role in VAD surgery by facilitating faster recovery, which is important for patients at very high risk.
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Affiliation(s)
- Jonida Bejko
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
| | | | | | - Guido Di Gregorio
- Department of Medicine Anesthesiology, University of Padua, Padua - Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
| | - Giulio Rizzoli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua - Italy
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