Clinical Characteristics and Survival in Pulmonary Hypertension Due to Chronic Lung Disease

Abstracts S363 to 92.0] mmHg to minimum 34.5 [18.0 to 57.0] mmHg, late 42.7 [21.0 to 88.0] mmHg (p < 0.001). The mean followed-up time from first RHC were 5.0 [0.12 to 20.2] years to minimum point and 6.7 [0.13 to 24.2] years to late point, respectively. Conclusion: The recent prognosis of I/PAH patients was also improved in Japan as well as Europe and United States. Patients were received multiple PAH medications including high dose parenteral prostanoid to improve hemodynamic status. This adequate utilization of medical resources is owing to Japanese national support to cover medical cost. On the other hand, the shortage of the brain-dead donor is serious enough to oblige patients to wait long time for lung transplantation in Japan.

1( 111) RVOT-VTI/PASP Is a Novel Noninvasive Parameter of Pulmonary Artery Compliance and Improves After Treatment with Pulmonary Hypertension-Specific Therapy M.S. Tanna ,1 A. Fox,1 G.S. Troutman,1 P.T. Bhattacharya,1 J.N. Menachem,1 F. Mao,1 E.Y. Birati,1 P.R. Forfia,2 A. Vaidya,2 J.A. Mazurek.1  1University of Pennsylvania, Philadelphia, PA; 2Temple University, Philadelphia, PA. Purpose: Pulmonary artery compliance (PAC) is an independent predictor of mortality in patients with pulmonary hypertension (PH). We have previously shown that the ratio of echocardiography derived right ventricular outflow tract velocity time integral (RVOT-VTI; an estimate of stroke volume) to pulmonary artery systolic pressure (PASP) correlates with PAC measured by right heart catheterization. We sought to determine whether PH-specific therapy improves PAC in patients with pulmonary arterial hypertension (PAH). Methods: This is a retrospective cohort study of adult patients with PAH who were referred to the PH center at the University of Pennsylvania. All patients met criteria for PAH as delineated by the 2013 Nice criteria, and underwent echocardiography at baseline and one year. The primary study outcome was change in PAC, as estimated by RVOT-VTI/PASP, after one year of PH treatment. Results: There were 57 patients who met inclusion criteria. Median age was 59 years [interquartile range 47, 68] and 79% were female. At one year, 86% of patients were on a phosphodiesterase type 5 inhibitor. The mean RVOT-VTI/PASP at enrollment was 0.18±0.13 cm/mmHg which increased to 0.28±0.17 cm/mmHg (p< 0.0001) after one year of PH-specific therapy. Conclusion: Noninvasively assessed PAC, as measured by RVOT-VTI/PASP, increases significantly after one year of PH-specific therapy and may have a role in the risk stratification of these patients. Further studies are needed to elucidate whether this measure can be used to guide therapy.

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1( 113) Left Ventricular Assist Device Improves Type II Pulmonary Hypertension with High Pulmonary Vascular Resistance A. Selim ,1 E. Raichlin,1 A. Burdorf,1 J. Um,2 A. Siddique,2 M. Moulton,2 B.D. Lowes,1 R. Zolty.1  1Cardiology, University of Nebraska Medical Center, Omaha, NE; 2Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE. Purpose: Pulmonary hypertension (PH) is a known contributing factor to poor outcomes in systolic heart failure patients. The role of left ventricular assist devices (LVADs) in improving PH with increased pulmonary vascular resistance (PVR) is not clear. In our study, we investigated the changes in pulmonary artery pressure (PAP), along with the changes in the hemodynamic markers for pulmonary hypertension, including pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG), in patients post LVAD placement. Methods: We studied a cohort of 221 systolic heart failure patients (177 males, 80%) who underwent LVAD implantation at the University of Nebraska Medical Center between 2009 and 2015. The mean PAP, pulmonary capillary wedge pressure (PWP) and PVR were obtained from the right heart catheterization done within 60 days before LVAD, and repeated 118 days (+/- 63 days) after LVAD implantation. Results: Mean age at the time of LVAD implantation was 55.6 +/-14 years. Mean PA pressure dropped from 37 +/- 11 mmHg before LVAD to 25.5 +/-10 mmHg post LVAD (P< 0.001). There was a significant decrease in the PVR post LVAD placement (from 3.4 +/-2.0 to 2.3 +/- 1.4, P< 0.001), and a decrease in the transpulmonary gradient (from 12.8 +/- 6.4 to 10.5 +/- 6.0, P< 0.001). In a subset of patients that had PAP>  25 mmHg and PVR >  3 woods units (n=  34, 29 males, age 52 +/- 14), there was a significant drop in mean PVR and mean PAP (2.7 +/-1.7 vs. 4.6+/- 1.6, P< 0.001, and 13 +/- 5.6 vs. 17.7 +/- 6, P< 0.001 respectively). In this group, twenty patients (59%) had their PVR dropped down to below 3 woods unit after LVAD placement (mean PVR =  1.8 +/- 5). Conclusion: LVAD improves pulmonary hypertension in systolic heart failure patients with elevated pulmonary vascular resistance. 1( 114) Clinical Characteristics and Survival in Pulmonary Hypertension Due to Chronic Lung Disease K. Prins , L. Rose, C. Carlson, M. Pritzker, K.E. Weir, F. Kazmirczak, T. Thenappan.  Medicine- Cardiology, University of Minnesota, Minneapolis, MN. Purpose: Pulmonary hypertension (PH) due to chronic lung disease (WHO Group 3) increases cost and is associated with worse survival when compared to patients with chronic lung disease without PH. However, the clinical characteristics of patients with WHO Group 3 PH are not well described as compared to patients with pulmonary arterial hypertension (WHO group 1 PAH). Objectives: To determine the clinical characteristics, hemodynamics, right ventricular (RV) function, and survival in patients with WHO Group 3 PH and to compare it to patients with WHO Group 1 PAH. Methods: We studied all patients with WHO Group 3 PH (n= 98) and WHO Group 1 PAH (n= 162) referred to our center. We used Kaplan-Meier method and Cox proportional hazard analysis to determine survival and independent predictors of mortality. Results: WHO Group 3 patients were older and had a higher proportion of males than Group 1 patients. When assessing invasively measured hemodynamics, Group 3 patients had lower mean pulmonary arterial pressures (40±10 vs. 45±14, p= 0.002), lower pulmonary vascular resistance (7.5±3.4 vs. 10.5±6.4, p< 0.001), and higher pulmonary arterial compliance (1.7±0.9 vs. 1.3±0.7, p< 0.001) than Group 1 patients. However, Group 3 patients walked less on the six-minute walk test (237±112 vs. 332±140 meters, p< 0.001) and had lower RV fractional area change (29±10% vs. 33±11%, p= 0.024) when compared to Group 1 patients. Finally, Group 3 PH had a worse survival when compared to Group I PAH (Figure 1). Conclusion: Group 3 PH patients had poor exercise capacity, lower RV function, and worse survival despite having less severe pulmonary vascular disease when compared to Group 1 patients.

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The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017 1( 116) WITHDRAWN

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1( 115) Effects of Ambulatory Inhaled Nitric Oxide on Exercise Induced Increases in Pulmonary Pressures R.A. Davey ,1 A. Raina,2 R.L. Benza.2  1Division of Cardiology, Western University, London, ON, Canada; 2Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA. Purpose: Pulmonary arterial hypertension (PAH) is characterized by progressive increases in pulmonary vascular resistance (PVR) and subsequent reductions in cardiac output (CO); these changes are further exacerbated by exercise. Inhaled nitric oxide (iNO) can decrease PVR and improve CO. We sought to investigate the effects of a novel ambulatory delivery device for iNO (iNOPulse DS) in patients with the CardioMEMS implantable hemodynamic monitor both before and after exercise. Methods: 10 subjects were consented and enrolled in the study with PAH from any cause (4= connective tissue disease, 5= idiopathic, 1= familial) and previously had a CardioMEMS device implanted as part of the ongoing VITA study. CardioMEMS readings were taken at 6 time points: baseline, immediately after a 6 minute walk test (6MWT), after 30 minutes rest (then started on iNO), 30 minutes after drug wash-in, immediately after repeat 6MWT and a final reading 30 minutes after drug discontinuation to ensure return to baseline. Results: With exercise, parameters including pulmonary artery pressures (PAP) (mean PAP 7.72±1.80mmHg,p= 0.002), cardiac index (CI) (0.61±0.25 L/min/m2,p= 0.04), and RV stroke work index (RVSWI) (3.39±1.03 g/m2/beat, p= 0.01) all significantly increased. The effect of iNO at rest did not reach significance but did show a consistent trend toward improvement in PAP, CI and RVSWI and this trend was preserved with exercise. In comparing the absolute differences in measured characteristics in the pre/post exercise group with and without iNO, again the trend was preserved (figure). Importantly, there were no significant negative effects recorded: oxygen requirements, 6MWT distances, and subjective dyspnea scores all remained stable. Conclusion: This study provides important information for further exploration of a novel delivery device for iNO in an ambulatory setting and its role in blunting pulmonary pressures with and without exercise and reinforces existing knowledge about the effects of iNO with exercise.

Perioperative Extracorporeal Membrane Oxygenation-Based Protocol for Acute Pulmonary Embolectomy: Technique and Preliminary Results F. Ius ,1 C. Fegbeutel,1 C. Kühn,1 I. Tudorache,1 G. Warnecke,1 M. Roumieh,1 N. Koigeldiyev,1 K. Olsson,2 M. Hoeper,2 A. Haverich,1 S. Cebotari.1  1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; 2Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. Purpose: Acute pulmonary embolectomy carries a high in-hospital mortality risk. At our institution, since 2012, we have applied a management protocol using perioperative veno-arterial extracorporeal membrane oxygenation (v-a ECMO) support in all patients with acute pulmonary embolism, in order to reduce the impact of hemodynamic instability. In this study, we present the preliminary results of perioperative ECMO-therapy. Methods: We retrospectively reviewed all patients who underwent embolectomy due to acute pulmonary embolism at our institution between November 2012 and September 2016. In these patients, the first line therapy was v-a ECMO implanted percutaneously in the femoral vessels. This was intraoperatively switched to cardiopulmonary bypass support and then again to v-a ECMO support at the end of surgery. V-a ECMO was continued postoperatively in the intensive care unit. Results: Eight patients (mean age 61±11 years, all male patients) underwent pulmonary embolectomy for acute embolism. Preoperatively, 2 (25%) patients showed concomitant chronic thromboembolic pulmonary artery hypertension, 5 (62%) patients required mechanical ventilation, 6 (75%) patents had required v-a ECMO support for cardiogenic shock and 4 (50%) patients had undergone lysis. V-a ECMO was implanted before beginning of the anaesthesia in 2 (25%) patients. Intraoperatively, cardiopulmonary and cross clamp times (minutes) amounted to 135±57 and 66±34, respectively. Six (75%) patients required deep hypothermic circulatory arrest (15±12 minutes). Three (37%) patients underwent combined cardiac procedures (cardiac redo n= 1). V-a ECMO was continued postoperatively in all patients and weaned successfully after a mean of 4±2 days. Four (50%) patients were successfully extubated before ECMO weaning (awake-ECMO). Two (25%) patients required rethoracotomy for bleeding and 2 (25%) temporary dialysis. No patient showed reperfusion oedema. There was no in-hospital mortality. Conclusion: Our v-a ECMO based protocol for acute pulmonary embolectomy led to stabilization of preoperative compromised haemodynamic. Postoperative ECMO prevented reperfusion oedema and provided good postoperative results in high risk patients. Weaning from mechanical ventilation before weaning from v-a ECMO remains an effective strategy to improve outcomes. 1( 119) Meticulous Closure of Collateral Blood Flow in the Perihilar Mediastinal Pleura Decreases Bleeding and Surgical Mortality in Lung Transplant Recipients with Pulmonary Hypertension K. Hashimoto ,1 S. Sugimoto,1 K. Imanishi,1 T. Kurosaki,2 K. Miyoshi,1 S. Otani,2 M. Yamane,1 T. Oto.2  1Department of General Thoracic Surgery, Okayama University Hospital, Okyama, Japan; 2Department of Organ Transplant Center, Okayama University Hospital, Okyama, Japan. Purpose: Surgical risk factors associated with LT have been shown to include hemorrhage, pulmonary hypertension (PH), and cardiopulmonary bypass (CPB). Massive hemorrhage during LT necessitates increased volume of infusion and transfusion, causing primary graft dysfunction after LT. Although CPB should be avoided to decrease bleeding in LT if possible, LT for PH often require CPB. Especially, recipients with PH have collateral blood flow in the perihilar mediastinal pleura, which could be the source of bleeding