Haemodynamic Response of Pulmonary Hypertension Secondary to Left Heart Disease with Continuous Flow Left Ventricular Assist Device Therapy (CF-LVADS): Post-Transplant Outcomes

Abstract

LVAD implantation is often utilised as a bridge to transplantation or candidacy in those with pulmonary hypertension secondary to left heart disease (PHLHD). Pulmonary hypertension portends poorer outcomes post-transplant. We compared pre and post implantation haemodynamic response and outcomes in patients who normalise transpulmonary gradient (TPG) to those who do not. Retrospective review of CF-LVAD patients was conducted for right heart catheter derived haemodynamic measurements and post-transplant outcomes from a single instituition. 219 CF-LVADs were implanted between October 2004 and September 2019. 48 patients had TPG greater than 12 prior to implantation. 1 patient was excluded for incomplete data. 28 patients normalised TPG (Gp 1) and 17 patients had elevated TPG (Gp 2) at first follow up. Table 1 describes the haemodynamic assessment of the two groups. At baseline, Gp 1 patient had significantly lower PVR, p=0.04. At follow-up, Gp 1 patients had significantly lower RAP, p<0.0001 and PP, =0.003. Gp 1 patients were more likely to survive on pump, p=0.03, more likely to be transplanted, p=0.03 and survived longer post transplant, p=0.04. Baseline pulmonary vascular resistance may provide prognostic information in CF-LVAD patients with PHLHD. Early normalization in TPG is associated with favourable haemodynamic response.