Intravenous sildenafil in right ventricular dysfunction with pulmonary hypertension following a heart transplant

Overview

The objective of the present work is to describe the experience with intravenous (IV) sildenafil in heart transplant
(HT) patients with reactive pulmonary hypertension (PH) who developed right ventricular dysfunction (RVD) in
the immediate postoperative period. The first 5 patients who received IV sildenafil followinga HT are presented.
The HTs took place between March 2011 and September 2012 in patients aged 37 to 64 years; all patients were
male. Prior to the HT, mean pulmonary artery pressure (mPAP) was 32-56 mmHg. In all cases, the hemodynamic
study demonstrated PH reactivity (positive vasodilator test with nitric oxide). All 5 patients developed RVD with
hemodynamic instability immediately after the HT, despite the administration of nitric oxide from the time of
intubation prior to the implant, optimal medical treatment in all cases, and a ventricular assist in 2 cases. In all
patients, IV sildenafil was initiated at 10 mg/8 h for 48 h and was subsequently increased to 20 mg/8 h. in its oral
formulation until discharge from the hospital. The change in pulmonary pressure was assessed using a Swan-Ganz
catheter. Ventricular function was assessed using echocardiography. Length of stay in the Resuscitation Unit and
mid-term survival were also assessed.
Average time of extracorporeal circulation was 200 ± 110 min and organ ischemic time was 210 ± 95 min. All of
the patients demonstrated pulmonary and systemic hemodynamic improvement, as well as recovery of right ventricular
function after completing the treatment with IV sildenafil. The stay in the Resuscitation Unit lasted 3-25
days. All the patients were discharged from hospital with no mortality to date. Intravenous sildenafil improves
right ventricle hemodynamics associated with pulmonary hypertension post-HT. Prophylactic prevention with
this drug could be indicated for patients with reactive PH who are about to receive a transplant.

Keywords

Cardiac transplant, PDE-5 inhibitor, Intravenous sildenafil, Pulmonary hypertension, Right ventricular dysfunction.

Disclosure

Financial support: None

Correspondence

Ignacio J. Sánchez Lázaro avenida Ausias March 2 esc 2, pta 15 46111 Rocafort Valencia, Spain ignaciosanchezlazaro@gmail.com

Received

2014-05-20T00:00:00