Novel Use of Pulmonary Artery Pressure Monitoring After a Total Artificial Heart Implantation

Abstract

<h3>Introduction</h3> The use of total artificial heart (TAH) implantation remains of limited use in the United States for patients with biventricular heart failure. One subgroup of patients that have been supported by TAH include patients with pulmonary hypertension that are not candidates for combined heart lung transplantation. These patients are difficult to manage after TAH implantation, as right heart catheterization cannot be performed to guide post surgical therapy. <h3>Case Report</h3> GF is a 49 year old male with ischemic cardiomyopathy on a home milrinone infusion with a left ventricular thrombus, pulmonary embolism, and pulmonary sarcoidosis. He presented with shortness of breath and fatigue. Right heart catheterization demonstrated severely decreased cardiac index (1.59L/min/m2 on thermodilution and 1.68 L/min/m2 on Fick) and severe pulmonary hypertension (transpulmonary gradient 36 mmHg, pulmonary vascular resistance 10.6 Woods Units, pulmonary artery (PA) pulsatility index 1.88). Intra-aortic balloon pump was placed for support and a PA catheter was left in place for continuous hemodynamic monitoring. He continued to decline and required escalation to extracorporeal membrane oxygenation support. He was listed for a heart transplant, but due to persistent severe pulmonary hypertension and new onset bacteremia he was made inactive and the decision was made to pursue alternative mechanical support with a TAH. Since right heart catheterization cannot be performed on patients with a TAH, a pulmonary artery sensor was placed in the left pulmonary artery one day prior to TAH implantation. Postoperatively, the TAH functioned well and the PA pressures were monitored easily with a bedside sensor. Initially, PA pressures ranged from 61-70/36-47 mmHg, but with medical optimization they improved to 37-48/20-27 mmHg by postoperative week 7 and he was relisted for transplant. <h3>Summary</h3> We identified a novel use for a pulmonary artery pressure sensor in a total artificial heart patient to help guide post implantation strategies. Our patient successfully had decreased pulmonary artery pressures and advanced to heart transplant listing.