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Correspondence to Author: Lagrue Simon¹, Valente Federica², RacapéJudith^{3 4} , Dewachter Celine² ,Vachiéry Jean Luc²,Roussoulières Ana² 

Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
2. Department of Cardiology, Hôpital Universitaire Erasme, Brussels, Belgium
3. School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
4. Chair in Health and Precarity. Faculty of Medicine, Universite libre de Bruxelles, Brussels, Belgium

Abstract: 
Background : Pulmonary hypertension (PH) is a common complication of heart failure (HF) with a significant impact on disease progression, and mortality. Left ventricular assist device (LVAD) implantation can improve haemodynamic status and survival as a “bridge to transplantation”. Aim of this study is to characterise haemodynamic after LVAD implantation based on the latest definitions of the PH Guidelines 2022, and to identify predictors of haemodynamic changes.
Methods : Patients with advanced HF with reduced ejection fraction (HFrEF) implanted with LVAD between 2011 and 2021 were retrospectively reviewed. Variables obtained by right heart catheterisation (RHC) were compared between baseline (T1) and after LVAD implantation (T2). Difference between pulmonary vascular resistance (∆PVR) at T1 and T2 was analysed by linear regression.
Results : Of the 100 patients with LVAD implantation, 37 patients were selected for the analysis. Mean age was 49 ± 13 years and 76 % were male. Thirty-three out of 37 patients (91.7%) had PH at baseline, whose 27 patients (75%) with combined post-capillary and pre-capillary (Cpc) PH. At T2, PH was observed in 20 out of 37 patients (54.1%) whose 6 patients (16.7%) with Cpc-PH. Significant reductions in mean pulmonary arterial pressure (22 ± 8 mmHg, ∆ = - 14 mmHg, p 0.001) and pulmonary vascular resistance (2.3 ± 1.1 WU, ∆ = - 1.0 WU, p 0.001) were observed. Linear regression showed that cardiac index was inversely correlated with ∆PVR.
Conclusions : LVAD implantation resulted in a significant improvement in PH, suggests that PH in end-stage HFrEF is mostly due to a passive mechanism.

Citation:

Lagrue Simon.Left Ventricular Assist Device To Treat PostCapillary Pulmonary Hypertension. Annals of Thoracic Surgery 2024.