Abstract
Introduction: The new generation continuous-flow left ventricle assist devices (LVAD) is an option for heart transplantation for end-stage heart failure. These kind of devices which developped with new technology, are implanted widely all over the world for bridge to transplantation as well as destination therapy. The effect of LVAD therapy on pulmonary artery pressure (PAP) in patients with fixed pulmonary artery hypertension (PAH) who are not good candidate for heart transplant, is an important research topic. In this study, we evaluated the course of PAP in LVAD therapy and its effect to post-transplant results. Materials-Methods: Between December 2008 and June 2013, continuous-flowLVAD implantation were performed in 73 patients. Mean age was 48.39 years and 87% was male. The common etiology for heart failure was Idiopathic dilated cardiomyopathy (69%). 9 of 73 patients (12,3%) were succesfully bridged to transplantation. 8 patients with fixed PAH were included in this study. PAP levels were retrospectively compared before LVAD, after LVAD and after heart transplantion. Results: Mean PAP before LVAD,after LVAD therapy and after heart transplant was respectively 59,6 mmHg,34.8mmHg and 32.8mmHg. The reduction of PAP was evident in patients supported with LVAD more than 60 days and consequently complications related to PAH were lower in this group. Two patients were died in early period of after heart transplant, the common feature of them was short support time after LVAD. Mean support time was 34 days. PAP was still high after LVAD and the main cause of mortality was right heart failure related multi-organ failure. Conclusion: The study is limited due to low-number of patients. But the decline of fixed PAH even it is refractory to vasodilator therapy was found in our analysis. As a conclusion we think that LVAD therapy before heart transplantation, in patients with decompansated heart failure and severe PAH, improves the results of heart transplantation.
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