ABC Heart Fail Cardiomyop 2022; 2(2): 136-137
Biologic Left Ventricular Assist: A New Strategy for Patients with Advanced Heart Failure with Pulmonary Hypertension
Fábio Antônio Gaiotto
, Samuel Padovani Steffen
Pulmonary arterial hypertension due to increased vascular resistance is a clinical condition that directly impacts the prognosis of patients with heart failure (HF), and it is considered one of the main contraindications to orthotopic heart transplantation. Although hemodynamic values vary in the literature, there is a consensus that pulmonary artery systolic pressure above 50 mmHg, transpulmonary gradient above 15 mmHg, and pulmonary vascular resistance above 3 Wood units, when unresponsive to vasodilators, contraindicate orthotopic transplantation. Therapeutic strategies to decrease or reverse this condition are a challenge in clinical practice, which, if resolved, may allow definitive treatment of HF with orthotopic transplantation.
The use of long-term continuous-flow left circulatory assistance devices as a bridge to candidacy is a reality in large transplant centers in developed countries. Several studies have demonstrated that device implantation not only leads to the expected eligibility for orthotopic transplantation in some patients; it also improves the quality of life of patients for whom it ends up remaining as the target therapy. In a study recently carried out by Ruan et al, it was demonstrated that, approximately 6 months after device implantation, there was a reduction and stabilization of pulmonary pressure. The reversal of pulmonary hypertension through left assistance devices is possible, given that there is an important decrease in filling pressures by means of the continuous emptying of the left ventricle.
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