Background

Heart transplantation remains the gold standard for the treatment of end-stage heart failure, but severe pulmonary hypertension (PH) poses a significant challenge due to the increased risk of complications after surgery. International guidelines classify severe PH as a relative contraindication to transplantation, requiring meticulous preoperative management.

Case presentation

We present the case of a 58-year-old man with severe heart failure and PH who received intra-aortic balloon pump (IABP) support for 62 days. Through targeted medical therapy and meticulous fluid management, remarkable hemodynamic improvements were achieved, exceeding the threshold for surgical contraindication. This allowed for a successful heart transplantation. Postoperatively, the patient experienced transient hemodynamic instability, which was effectively managed with vasopressor therapy and inhaled nitric oxide. With continued perioperative management, the patient experienced a smooth recovery and achieved a favorable outcome.

Conclusion

This case highlights the effectiveness of prolonged IABP assistance in reversing severe PH prior to transplantation, thereby facilitating successful heart transplantation. By implementing rigorous comprehensive perioperative management, patients with severe pulmonary hypertension can achieve positive outcomes after transplantation.