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Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation
Author(s) -
PerezVilla Felix,
Farrero Marta,
Cardona Montse,
Castel Maria Angeles,
Tatjer Irene,
Penela Diego,
Vallejos Isabel
Publication year - 2012
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/j.1399-0012.2012.01689.x
Subject(s) - bosentan , medicine , transplantation , heart transplantation , pulmonary hypertension , cardiology , prospective cohort study , surgery , hemodynamics , vascular resistance , endothelin receptor , receptor
Background Increased pulmonary vascular resistance ( PVR ) is associated with increased right ventricular failure and mortality after heart transplantation. Methods In this prospective study, 22 patients considered high‐risk candidates for heart transplantation because of severe pulmonary hypertension ( PVR = 6 ± 2 Wood units; transpulmonary gradient 22 ± 7 mm Hg ), received bosentan 125 mg bid. Right heart catheterization was repeated after four months (n = 22) and 12 months (n = 9). Eleven patients who declined participation in the study were considered as control group. Results After four months, PVR decreased by 38% in patients receiving bosentan (n = 22), while it increased by 25% in the control group (p = 0.001). Those patients who received bosentan for 12 months (n = 9), experienced a 60% reduction in PVR compared to baseline (p = 0.003). Only three patients (14%) had no hemodynamic improvement with bosentan. After bosentan therapy, 14 patients (64%) underwent heart transplantation. Patients with high PVR who received bosentan showed a trend toward better one‐yr survival after transplantation than patients with PVR ≤ 2.5 Wood units transplanted in the same period of time (93% vs. 83%). Conclusions In patients considered high‐risk candidates for heart transplantation because of high PVR , therapy with bosentan is associated with a significant reduction in PVR and a good outcome after transplantation.