• Bruno Soares da Silva Rangel, Bruno Biselli, Nádia Romanelli Quintanilha, Mônica Samuel Avila, Paulo Manuel Pêgo-Fernandes, Fabio Biscegli Jatene, Roberto Kalil Filho, and FerreiraSilvia Moreira AyubSMA0000-0002-9271-8233MD, PhD. Attending Physician, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil; and Attending Physician, Hospital Sírio-Libânes (.
• MD. Attending Physician, Hospital Sírio-Libânes (HSL), São Paulo (SP), Brazil; and Attending Physician, Hospital Vila Nova Star, São Paulo (SP), Brazil.
• Sao Paulo Med J. 2022 May 1; 140 (3): 505508505-508.

BackgroundSevere pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear.ObjectiveTo evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction.Design And SettingCross-sectional study in a general hospital in São Paulo, Brazil.MethodsThis was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected.ResultsFour patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%.ConclusionVAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.

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