Prevention of right heart failure after left ventricular assist device implantation by phosphodiesterase 5 inhibitor.

Abstract

Right ventricular (RV) function immediately after left ventricular assist device (LVAD) implantation is a crucial prognostic factor. RV failure is linked to increased mortality and worse outcome. A phosphodiesterase 5 inhibitor, sildenafil, was shown to decrease pulmonary vascular resistance and pulmonary artery pressure post-LVAD. We report on a series of heart failure patients, and the effect of sildenafil on the incidence of RV failure after LVAD implantation. We retrospectively analyzed the data of end-stage heart failure patients who underwent LVAD implantation with pulmonary hypertension and RV dysfunction prior to surgery. Patients were divided into two groups; group 1: patients who received sildenafil perioperatively, and group 2: patients who did not receive sildenafil. Hemodynamic and echographic data were collected before and after surgery. Fourteen patients were included, 8 patients in group 1 and 6 in group 2. Sildenafil was administered with a mean dose of 56.2 ± 9.4 mg in group 1 and was able to significantly reduce right heart failure incidence, and to demonstrate a significant reduction in pulmonary vascular resistance, pulmonary artery pressure, transpulmonary gradient, and a significant increase in cardiac output. In conclusion, sildenafil seems to have a promising role perioperatively in preventing acute RV failure postsurgery in patients with RV dysfunction and pulmonary hypertension, requiring LVAD therapy.

• Authors: Righab Hamdan, Hassan Mansour, Pierre Nassar, Mohamad Saab
• Journal: Artificial organs (Artif Organs) Vol. 38 Issue 11 Pg. 963-7 (Nov 2014) ISSN: 1525-1594 [Electronic] United States
• PMID: 24689700 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Chemical References

• Phosphodiesterase 5 Inhibitors
• Piperazines
• Purines
• Sulfonamides
• Sildenafil Citrate

Topics

• Adult
• Cardiac Output
• Female
• Heart Failure (prevention & control)
• Heart-Assist Devices
• Hemodynamics
• Humans
• Hypertension, Pulmonary (complications)
• Male
• Phosphodiesterase 5 Inhibitors (administration & dosage, therapeutic use)
• Piperazines (administration & dosage, therapeutic use)
• Purines (administration & dosage, therapeutic use)
• Retrospective Studies
• Sildenafil Citrate
• Sulfonamides (administration & dosage, therapeutic use)
• Treatment Outcome
• Ventricular Dysfunction, Right (prevention & control)