Sildenafil in heart transplant candidates with pulmonary hypertension

Abstract

In patients with pulmonary hypertension related to left ventricular systolic dysfunction, sildenafil seems to improve cardiac haemodynamics.

Management of pulmonary hypertension from left heart disease in candidates for orthotopic heart transplantation

“…Five patients were able to proceed with successful OHT and 6 with left ventricular assist device (LVAD). All patients with a PVR <3 Wood units after treatment survived, with survival in the group with PVR >3 being only 44% (41). In addition, hemodynamic parameters such as RV ejection fraction, PVR, and peak oxygen consumption improved in this population of HF patients with WHO group 2 PH with the administration of sildenafil (41).…”

Pulmonary hypertension: Barrier or just a bump in the road in transplanting adults with congenital heart disease

“…While the use of sildenafil has been studied in HT candidates for the management of PH and RV failure pre-and post-HT, these studies are small and single-center in nature. 39,40 Unpublished data from our center suggests that there is a significantly increased risk of short-term mortality in those patients on high-dose sildenafil (>20 mg TID) compared with those on low-dose or no sildenafil prior to HT.…”

“…Furthermore, the patient was never initiated on pulmonary vasodilators (specifically sildenafil), as there was improvement in his pulmonary vascular parameters with maximal systemic unloading. While the use of sildenafil has been studied in HT candidates for the management of PH and RV failure pre‐ and post‐HT, these studies are small and single‐center in nature . Unpublished data from our center suggests that there is a significantly increased risk of short‐term mortality in those patients on high‐dose sildenafil (>20 mg TID) compared with those on low‐dose or no sildenafil prior to HT.…”

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

“…PAH with ≥3 risk factors for left‐heart disease) . Another registry showed that the use of sildenafil improved haemodynamics in HF patients with post‐capillary PH before heart transplantation . However, the most important randomized trial that tested the administration of PDE5‐I (sildenafil) in 216 patients with HFpEF for 24 weeks did not show any improvement in exercise capacity or clinical status .…”

“…Selected studies assessing the effect of drugs on cardiopulmonary hemodynamics and clinical endpoints in HF classified according to the studied drug. [34][35][36][37][38][39][40][41][42]…”