High pulmonary vascular resistance index (PVRI) can lead to
right ventricular dysfunction and failure of the donor heart early after pediatric
heart transplantation. Oral pulmonary
vasodilators such as
sildenafil have been shown to be effective modifiers of pulmonary vascular tone. We performed a retrospective, observational study comparing patients treated with
sildenafil ("
sildenafil group") to those not treated with
sildenafil ("nonsildenafil group") after
heart transplantation from 2007 to 2012. Pre- and posttransplant data were obtained, including hemodynamic data from right heart catheterizations. Twenty-four of 97 (25%) transplant recipients were transitioned to
sildenafil from other systemic
vasodilators. Pretransplant PVRI was higher in the
sildenafil group (6.8 ± 3.9 indexed Woods units [WU]) as compared to the nonsildenafil group (2.5 ± 1.7 WU, p=0.002). In the
sildenafil group posttransplant, there were significant decreases in systolic pulmonary artery pressure, mean pulmonary artery pressure, transpulmonary gradient and PVRI (4.7 ± 2.9 WU before
sildenafil initiation to 2.7 ± 1 WU on
sildenafil, p=0.0007). While intubation time, length of inotrope use and time to hospital discharge were longer in the
sildenafil group, survival was similar between both groups. Oral
sildenafil was associated with a significant improvement in
right ventricular dysfunction and invasive hemodynamic measurements in pediatric heart transplant recipients with high PVRI early after transplant.