Review of Ambulatory Pulmonary Artery Catheterization in the Management of Advanced Heart Failure

The use of pulmonary artery catheterization (PAC) has declined secondary to associated complications and lack of demonstrable efficacy in the inpatient setting. Few studies have been published on the use of PAC in nonacute heart failure (HF) patients. The purpose of this study was to review the use of PAC in guiding advanced therapy in nonacute ambulatory HF patients. A retrospective observational study assessing our group's practice pattern with regard to the use of PAC in 515 ambulatory HF patients, outcomes, and adverse events that resulted from its use was performed. A total of 159 ambulatory HF patients were referred for PAC; 7% underwent heart transplant, 6% had ventricular assist device (VAD) placement, 18% underwent inotropic therapy, and 48% had addition of therapy while 14% had subtraction of therapy. Adverse events occurred in 4% of ambulatory PAC. Patients who underwent heart transplant, VAD, or inotropic therapy had significantly elevated pulmonary capillary wedge pressures, mean pulmonary artery pressures, and depressed cardiac index. Patients selected for inotropic therapy also had significantly elevated right atrial pressures and depressed ejection fractions. PAC use safely guided medical therapy in more than half of the nonacute ambulatory patients.