Continuous Flow Left Ventricular Assist Devices Improve Survival in Reactive but Not Fixed Type 2 Pulmonary Hypertension Compared with Medical Therapy

Abstract

Purpose Left heart failure is often complicated by pulmonary hypertension (T2PH), which can progress from ‘reactive' (RPH) to a'fixed' (FPH), significantly increasing morbidity and mortality. Continuous flow left ventricular assist devices (VAD) can reverse T2PH. We aimed to determine if treatment with VAD therapy improves morbidity and mortality in T2PH in both RPH and FPH. Methods and Materials All right heart catheters were analysed from Jan 2008 to Oct 2012 in our institution. Selection criteria: cardiac index 2.8 l/min/m 2 , pulmonary capillary wedge pressure>15mmHg, mean pulmonary arterial pressure>25mmHg, and transpulmonary gradient>15mmHg OR pulmonary vascular resistance (PVR)>3.0WU. FPH group had TPG>15 or PVR>3.0 after vasodilator challenge. Baseline and follow-up data were analysed. Results 62 patients had T2PH (15FPH, 47 RPH). 21 had VAD therapy (6FPH, 15RPH), and 41 medical therapy (9 FPH, 32 RPH). PVR was significantly reduced by VAD but not medical therapy [Table 1]. Cardiovascular admissions were reduced byVAD cf medical therapy (p Conclusions VAD therapy significantly improves survival in T2PH patients with RPH. Patients with FPH benefited from VAD therapy by having reduced hospital admissions but this study did not show a survival benefit. LVADMedicalFPH (n=6)RPH (n=15)FPH (n=9)RPH (n=32)NYHA4433INTERMACS1177002070036640110417465695-7003323PVR pre-treatment7.26.356.85.1PVR post-treatment3.82.116.24.6p-value (PVR change)