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Pattern of resolution of pulmonary hypertension, long‐term allograft right ventricular function, and exercise capacity in high‐risk heart transplant recipients listed under oral sildenafil
Author(s) -
De Santo Luca S.,
Buonocore Marianna,
Agrusta Federica,
Bancone Ciro,
Galdieri Nicola,
Romano Gianpaolo,
Maiello Ciro,
Amarelli Cristiano
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12387
Subject(s) - medicine , sildenafil , pulmonary hypertension , pulmonary artery , heart transplantation , cardiology , transplantation , hemodynamics , ventricle , surgery
Unresponsive pulmonary hypertension ( PH ) implies poor posttransplant outcomes. Data on late adaptation of the right ventricle ( RV ) are still few. This study evaluated three‐yr RV function and remodeling, exercise capacity, and hemodynamic data in a selected group of patients initially disqualified because of PH . Between May 2005 and December 2009, 31 consecutive patients were qualified for oral sildenafil because of unresponsive PH at baseline right heart catheterization ( RHC ). After a 12‐wk trial, RHC disclosed PH reversibility (mean PVR : 5.41 ± 3 Wood units, mean TPG 14.5 ± 5.6 mmHg, and mean systolic PAP 68.9 ± 15.1 mmHg), allowing listing even though as high‐risk procedures. All patients underwent heart transplantation. RV failure developed in three patients (9.6%), and hospital mortality was 3.2%. Protocol RHC disclosed pulmonary hemodynamic profile normalization within the third postoperative month, allowing weaning from sildenafil in the 30 hospital survivors. One‐ and three‐yr RHC s confirmed stable PH reversal (n = 26, all three‐yr survivors). Parameters of late RV function and remodeling proved satisfactory. Parameters of functional capacity (Vo 2 peak 19.7 ± 3.6 mL/kg/min and slope VE /Vco 2 34.8 ± 2.7) proved homogeneous to those measured in transplant recipients with normal preoperative pulmonary artery pressure. Oral sildenafil is effective in allowing candidacy, safe transplantation, and long‐term survival in PH recipients initially disqualified.