Arq. Bras. Cardiol. 2021; 116(2): 219-226
Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil
Sofia Lázaro Mendes
, Nadia Moreira, Manuel Batista
, Ana Rita Ferreira
, Ana Vera Marinho
, David Prieto, Rui Baptista, Susana Costa, Fatima Franco, Mariano Pego, Manuel de Jesus Antunes
This Original Article is referred by the Short Editorial "Sildenafil as an Eligible Heart Transplantation Therapy for Advanced Heart Failure Associated with Fixed Pulmonary Hypertension".
Abstract
Background
Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection.
Objective
This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension.
Methods
This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant.
Results
After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321).
Conclusion
In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226)
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