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Management of patients with advanced heart failure and type 2 pulmonary hypertension.

Session Poster Session 2

Speaker Marketa Hegarova

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Treatment
  • Session type : Poster Session

Authors : I Malek (Prague,CZ), M Hegarova (Prague,CZ), H Al-Hiti (Prague,CZ), J Vrbska (Prague,CZ), J Pirk (Prague,CZ), I Netuka (Prague,CZ), V Melenovsky (Prague,CZ)

Authors:
I Malek1 , M Hegarova1 , H Al-Hiti1 , J Vrbska1 , J Pirk1 , I Netuka1 , V Melenovsky1 , 1Institute for Clinical and Experimental Medicine - Prague - Czechia ,

Citation:

Introduction

Pulmonary hypertension (PH) is a common sequel of chronic heart failure, often with precapillary component. High pulmonary arteriolar resistance (PAR) is a negative prognostic sign and can complicate heart transplantation (HTx).

The aim of this analysis was to present the approach to the patients (pts) with precapillary PH who were listed for Htx in our institution.

Patients and methods

Consecutive patients (pts) evaluated for HTx during period 1/2010 – 12/2017 were analysed, with a view to subgroup with precapillary PH. Hemodynamic investigations were performed using Swan-Ganz thermodilution catether. Precapillary PH unacceptable for HTx was defined as PAR > 4 Wood units and/or transpulmonary gradient (TPG) > 15 mm Hg, measured under  euvolaemic conditions. Reversibility of PH was stated when PAR and TPG declined to values acceptable for HTx after testing by prostaglandin E1 or sildenafil.

Results

The criteria for unacceptable PH fulfilled 85 pts (69 men, 21-73 yrs). Reversibility of PH was achieved in 69 % of them.

Subsequently, all the pts were closely monitored in order to achieve optimal therapy. Fifty pts were treated with PDE5 inhibitor sildenafil (Revatio fi. Pfizer 60-120 mg/d).  Duration of therapy was 9-91, median 10 months. Thirty nine (78%) pts were responders, only one did not tolerate the treatment.

Left ventricular mechanical circulatory support Heart Mate II fi.Thoratec (MCS) was implanted in 39 pts, in 15 of them solely for PH. Decrease of PAR was achieved in 27/28 measured pts.

All the pts were listed, HTx was subsequently performed in 65 (77 %), 9 (11 %) died on waiting list (WL), one pt. was left on MCS, 2 were excluded for comorbities, others are still on WL.

HTx was performed  in 39 pts on special protocol („ovesized donor heart", postoperative NO inhalation) and in 26 pts on MCS. In the early postoperative period 10 (15 %) of pts developed transient right ventricular failure, none died due to graft failure.

Conclusions

Precapillary PH in pts with advanced HF require special management. With contribution of sildenafil and MCS majority of pts can proceed to  successful HTx.

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