Medically Refractory Pulmonary Hypertension: Treatment With Nonpulsatile Left Ventricular Assist Devices Christian D. Etz, MD, Henryk A. Welp, MD, Tony.

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Medically Refractory Pulmonary Hypertension: Treatment With Nonpulsatile Left Ventricular Assist Devices Christian D. Etz, MD, Henryk A. Welp, MD, Tony D.T. Tjan, MD, Andreas Hoffmeier, MD, Ernst Weigang, MD, Hans H. Scheld, MD, Christof Schmid, MD The Annals of Thoracic Surgery Volume 83, Issue 5, Pages 1697-1705 (May 2007) DOI: 10.1016/j.athoracsur.2007.01.019 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Nonpulsatile INCOR left ventricular assist device in preoperative standby with outflow conduit, pump case, drive line, and inflow conduit and auxiliary devices. The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Nonpulsatile INCOR left ventricular assist device; implanted, operative site. The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Shown is the chest X-ray with an INCOR left ventricular assist device three months after hospital discharge of an ambulatory patient waiting for elective orthotopic heart transplantation after improvement in pulmonary vascular resistance. The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Pulmonary vascular resistance (PVR) during nonpulsatile left ventricular assist device (LVAD) support (n = 10 patients). Shown is the PVR of each patient during LVAD support. The arrows mark further decline in PVR after three months of continuous left ventricular unloading. (● = patient 1; ○ = patient 2; ▾ = patient 3; ▵ = patient 4; ■ = patient 5; □ = patient 6; ♦ = patient 7; ◊ = patient 8; ▴ = patient 9; ▿ = patient 10.) The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Mean pulmonary artery pressure (PAP), mean pulmonary vascular resistance (PVR), and mean transpulmonary gradient (TPG) prior to and during left ventricular assist device (LVAD) support. The graph displays the means and standard deviations of the PAP, PVR, and TPG prior to and during LVAD support. The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG); acute prostaglandin testing and after 30 days on nonpulsatile left ventricular assist device (LVAD) support. Example of PVR, TPG, and cardiac index (CI): initial right heart catheterization with baseline and temporary drop during acute prostaglandin testing and final reduction to target values for orthotopic heart transplantation, after 30 days of nonpulsatile left ventricular unloading. (● = PVR [WU; Woods units]; ▾ = TPG [mm Hg]; ■ = CI [L/min/m2].) The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Pulmonary vascular resistance (PVR). Follow-up after orthotopic heart transplantation (oHTx; n = 4 patients). Shown is the PVR after oHTx subsequent to left ventricular assist device support in four patients. (● = patient 1; ○ = patient 2; ▾ = patient 3; ■ = patient 4.) The Annals of Thoracic Surgery 2007 83, 1697-1705DOI: (10.1016/j.athoracsur.2007.01.019) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions