Characteristics Associated with Improved Pulmonary Vascular Resistance Following LVAD Surgery

Purpose LVAD therapy improves pulmonary vascular resistance (PVR) in patients with heart failure, but the patient characteristics associated with PVR reduction are unknown. Methods Primary continuous-flow LVAD recipients in the INTERMACS registry with implant PVR ≥3 Wood units (WU) and at least one reported postoperative PVR were included. Post-implant PVR was modeled as a function of 29 covariates using multivariable linear mixed effects modeling. Results 3741 patients had pre- and post-implant PVR available, of which 1581 (42%) had implant PVR ≥3 WU. Median follow up time was 6 mo (range 1 wk to 102 mo). While median time to PVR Conclusion While LVAD therapy is associated with PVR reduction, about 1 in 6 LVAD recipients with high baseline PVR do not experience PVR normalization. Residual MR is associated with higher postoperative PVR, highlighting the need for prospective studies of concomitant surgical repair of preoperative MR. These data may help inform decision making regarding LVAD implant strategies for patients with pulmonary hypertension.