Pulmonary Hypertension and Implantable Invasive Hemodynamic Monitoring

Pulmonary hypertension (PH) poses a common complication for individuals with complete dextro-transposition of the great arteries (D-TGA) after atrial switch (AS) and congenitally corrected TGA (ccTGA) who exhibit subaortic right ventricles (sRVs). This study was published in the Heart journal by Marshall V. and colleagues.

A recent retrospective study has explored the utility of implantable invasive hemodynamic monitoring (IHM) in this patient population, revealing novel applications and its potential impact on heart failure hospitalisation (HFH) and device-related complications.

Patient Demographics

• The study involved 18 patients with sRVs.
• Median age: 43 years (range: 30-54).
• Diagnosis: 16 with D-TGA/AS, 2 with ccTGA.

IHM Applications

• Medical Therapy Titration: IHM played a crucial role in adjusting medical therapy for patients.
• Post-Ventricular Assist Device (VAD) Management: IHM facilitated medical management in individuals with transplant-limiting PH post-VAD.
• Serial Monitoring for Heart Transplant Referral: IHM enabled the continuous monitoring of pulmonary artery pressures, potentially eliminating the need for repeat catheterizations to identify optimal heart transplant referral times.

Clinical Impact

In a median follow-up of 23 months, the rate of HFHs per year remained similar to the period before IHM implementation.

• HFHs/year pre-IHM: Median 0 (IQR 0-1.0).
• HFHs/year post-IHM: Median 0 (IQR 0-0.8) (p=0.984).

Device-Related Complications

Device migration occurred in one patient, but without long-term consequences.

The study underscores the diverse applications of IHM in patients with sRVs, offering valuable insights into managing PH in this complex population. IHM demonstrated effectiveness in medical therapy titration, post-VAD management, and serial monitoring for heart transplant referral. Notably, the overall impact on HFH rates was minimal, emphasizing the potential of IHM in optimizing patient care without significantly altering hospitalization outcomes. The occurrence of a single device-related complication, with no lasting effects, highlights the safety profile of IHM in this context.

Reference

Marshall, W. H., V., Mah, M. L., DeSalvo, J., Rajpal, S., Lastinger, L. T., Salavitabar, A., Armstrong, A. K., Berman, D., Lampert, B., Wright, L. K., Hickey, J., Metzger, R., Nandi, D., Gajarski, R., & Daniels, C. J. Novel uses for implanted haemodynamic monitoring in adults with subaortic right ventricles. Heart (British Cardiac Society), heartjnl-2023-323206. https://doi.org/10.1136/heartjnl-2023-323206