Abstract: SA-PO301
Application of a Central Iliac Arteriovenous Coupler Device in Severe Resistant Hypertension: A 3.5-Year Follow-Up
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Jung, Susanne, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- Ott, Christian, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Karg, Marina V., University Hospital of Erlangen, Erlangen, Germany
- Bosch, Agnes, University Hospital of Erlangen, Erlangen, Germany
- Schmid, Michael, University Hospital Erlangen, Erlangen, Germany
- Achenbach, Stephan, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Schmieder, Roland E., University Hospital Erlangen, Erlangen, Germany
Introduction
In patients with resistant hypertension (RH), iliac arteriovenous (AV) coupler implantation leads to blood pressure (BP) reduction via decreased total vascular resistance and improved arterial compliance. However, long-term efficacy and safety need to be further explored. We report on the first case of 3.5-year follow-up (FU) in a patient treated by coupler implantation, who underwent repeated right heart catheterization (RHC).
Case Description
A patient with RH was admitted to hospital. Despite treatment with 6 anti-hypertensives his BP was poorly controlled. Previously, he had undergone renal denervation, not leading to significant BP decrease. Therefore an AV coupler was implanted in our catheterization laboratory, causing a periinterventional BP decrease from 198/90 to 163/69mmHg. The patient was discharged with a BP of 122/71mmHg. After 3 months there was a sustained BP decrease, whereas later it was fluctuant (office BP: 147-173/85-95mmHg, ABPM: 153-166/81-94mmHg) probably due to medication non-adherence, confirmed by a urinary screening test. One year later the patient was hospitalized with iliac venous stenosis, which was treated by venoplasty and stenting. After 3.5 years he complained about progressive dyspnea and weight gain. FU RHC showed an increased pulmonary artery- , right atrial- and wedge-pressure as well as cardiac index and a decreased pulmonary vascular resistance. Central aortic pressure had decreased indicating device effectiveness. An invasive closure maneuver led to an immediate BP increase (+30mmHg) and a similar decrease after re-opening of the coupler, verifying its functionality. To unload the right ventricle, an intensive diuretic therapy was introduced leading to clinical improvement.
Discussion
This is the first case of 3.5-year FU after arteriovenous coupler implantation, leading to significant BP decrease. We verified a proper long-term function of the device and demonstrated changes in hemodynamic parameters related to volume congestion, which were resolved by an intensified diuretic therapy.
Hemodynamic changes obtained by RHC
| Date of RHC | Right atrial pressure [mmHg] (s/d/m) | Pulmonary artery pressure [mmHg] (s/d/m) | Cardiac index (Fick) [l/min/m^2] | Pulmonary vascular resistance [dyn x sec/cm^5 ] | Central aortic BP [mmHg] (s/d/m) |
| Baseline | 11/10/7 | 36/13/21 | 2.6 | 160 | 214/105/141 |
| 0.5-year follow-up | 13/9/7 | 39/13/23 | 3.0 | 129 | 214/92/133 |
| 3.5-year follow-up | 14/13/12 | 56/20/35 | 4.1 | 114 | 165/70/105 |
S-systolic/d-diastolic/m-mean