Sildenafil in heart transplant candidates with pulmonary hypertension

Severe pulmonary hypertension is a usual contraindication to heart transplantation. A few studies have found that sildenafil has a favourable effect on haemodynamic variables in patients with severe left ventricular systolic dysfunction.

To report our clinical experience of sildenafil in patients with left ventricular systolic dysfunction and severe pulmonary hypertension.

All patients underwent echocardiography, radionuclide angiography, a cardiopulmonary exercise test and right heart catheterization before and after treatment with sildenafil. All patients were clinically stable and were receiving maximal tolerated doses of recommended drugs.

We included 18 patients, with a mean±standard deviation age of 47±13 years. After a median of 8.7 months (interquartile range, 4.4-13.5 months) on sildenafil, there was a significant improvement in New York Heart Association classification (P=0.02) and mean right ventricular ejection fraction (from 26±7% to 30±9%; P=0.008), with a decrease in the VE/VCO2 slope (from 52±11 to 44±11; P=0.009) and in pulmonary vascular resistance (from 5.3±1.9 Wood units to 3.3±1.8 Wood units; P=0.01). During follow-up, three patients had urgent heart transplantation, two had non-urgent transplantation and six had left ventricular assist device implantation. All patients with pulmonary vascular resistance<3 Wood units after sildenafil were alive, compared with four in the other subgroup (44% survival).

In patients with pulmonary hypertension related to left ventricular systolic dysfunction, sildenafil seems to improve cardiac haemodynamics.