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Pulmonary Pressure Assessment with the Total Artificial Heart

Joyce, David L.; Redfield, Margaret M.; Kushwaha, Sudhir S.; Behfar, Atta; Borlaug, Barry A.; Daly, Richard C.; Sandhu, Gurpreet S.; Joyce, Lyle D.
doi: 10.1097/MAT.0000000000000632
Case Series: PDF Only

Reversal of pulmonary hypertension has been observed in patients during a bridge to transplant with a left ventricular assist device. Total artificial heart (TAH) implant prevents subsequent right heart catheterization. Consequently, controversy exists over whether the prosthetic right ventricle improves or exacerbates pulmonary hypertension. A pulmonary artery (PA) pressure monitor was placed in two patients undergoing TAH implant, as a bridge to transplant. One patient had pulmonary hypertension at implant; the other had normal pulmonary pressures. Daily measurements were taken of systolic, diastolic, and mean PA pressures throughout support. Patient 1 received successful transplant after TAH support of 91 days. Systolic/diastolic (mean) PA pressures steadily decreased from 55/39 (28) mm Hg at implant to 29/18 (7) mm Hg currently. Patient 2 received support for 101 days before death due to abdominal ischemic complications. Pulmonary arterial pressures stayed consistent throughout this period, from 26/17 (20) mm Hg at implant to 23/13 (17) mm Hg at the time of death. These findings suggest that an implantable PA pressure monitor may be useful in optimizing hemodynamics and planning appropriate timing of transplant with TAH support.

Submitted for consideration September 2016; accepted for publication in revised form June 2017.

Disclosure: The authors have no conflicts of interest to report.

Mayo Clinic does not endorse specific products or services discussed in this article.

Presented as a podium presentation at the ASAIO 62nd Annual Conference; June 15–18, 2016; San Francisco, CA.

Correspondence: David L. Joyce, Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email: joyce.david1@mayo.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs