PULMONARY-HYPERTENSION IS NOT A RISK FACTOR FOR RVAD USE AND DEATH AFTER LEFT-VENTRICULAR ASSIST SYSTEM SUPPORT

Unlike transplantation candidates, patients with pulmonary hypertensio n (PHTN) and a high transpulmonary gradient do not appear to be at inc reased risk for right ventricular dysfunction after left ventricular a ssist system implant. To verify this observation, we reviewed 63 patie nts supported with the HeartMate (Thermo Cardiosystems, Inc, Woburn, M A) left ventricular assist system. Patients were divided into two grou ps: patients with PHTN (47 patients) had mean pulmonary artery pressur e >30 mm Hg and/or pulmonary vascular resistance >4 Wood units, and th e remainder of patients did not have PHTN (16 patients). Both groups w ere similar in age (mean, 51 years), gender distribution (% men, 83% v s 94%, not significant), and number of patients with ischemic cardiomy opathy (72% vs 69%, not significant). More patients in the group witho ut PHTN required extracorporeal membrane oxygenation support (38% vs 1 2%, p = .06). Right ventricular assist device support was instituted i n five (11%) patients with PHTN and four (25%) patients without PHTN. A significantly larger number of patients without PHTN died while on s upport (14% vs 44%, p = .01). Survival after transplantation in both g roups was >90%. Patients with PHTN have higher transpulmonary gradient , show a significant decrease in pulmonary pressure after left ventric ular assist system implantation, and have a higher transplantation rat e compared to patients without PHTN. A larger patient cohort is needed to determine if the absence of PHTN is a risk factor for RVAD need an d poor outcome after LVAS support.