Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil

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 HI Pulmonary hemodynamics were evaluated before Hi, 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 HI; 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.

Automated summary

The study showed that in patients with severe pulmonary hypertension pre-treated with sildenafil, early post-operative hemodynamics and prognosis were slightly worse than in patients without pulmonary hypertension, but after one year, the medium to long-term mortality proved to be similar.