Prostaglandin E1 bridge to heart transplantation - methods, technique, results

Heart transplantation (HTx) candidates who remain severely symptomatic despite optimal therapy are normally hospitalized. Continuous infusion of intravenous drugs from a portable pump may allow such patients to live fairly active life until a donor heart is found. Among the current potential bridging agents the synthetic β-agonist dobutamine is preferred for inotropic support. Prostaglandin E1 (PGE1), a naturally occurring substance with an eicosanoid structure and potent pulmonary and systemic vasodilator action, is another candidate for this indication. It was shown in a double-blind trial that PGE1 lowers pre- and afterload in patients with left ventricular failure who are already stabilized on catecholamines. In addition, an open pilot study of 54 patients suggested that chronic infusions with PGE1 at reduced dosages is a feasible and safe therapeutic approach to bridge end-stage heart failure patients and may yield desirable effects in a subset of patients in the absence of intropic support with dobutamine. Meanwhile, we have demonstrated in a recent prospective randomized trial that PGE1 is superior to dobutamine as a single bridging drug with regard to improving event-free survival rates in this high-risk patient population.