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Post-Implant Phosphodiesterase-5 Inhibitors in Patients with Left Ventricular Assist Device: A Systematic Review and

Andrew Xanthopoulos1, Dimitrios E Magouliotis2, Konstantinos Tryposkiadis3

  • 1Department of Cardiology, University Hospital of Larissa, 411 10 Larissa, Greece.

Journal of Clinical Medicine
|October 27, 2022
PubMed

Insights

Post-implant phosphodiesterase-5 inhibitors (PDE-5i) in left ventricular assist device (LVAD) patients reduced mortality and thrombotic events like stroke and pump thrombosis. However, PDE-5i use was linked to an increased risk of gastrointestinal bleeding.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Technology

Background:

  • Hemocompatibility issues persist despite advancements in left ventricular assist device (LVAD) technology.
  • Optimizing patient management requires novel pharmacological interventions to mitigate hemocompatibility-related events.
  • Third-generation LVADs still face challenges with blood-material interactions.

Purpose of the Study:

  • To systematically review and meta-analyze the safety and efficacy of post-implant phosphodiesterase-5 inhibitors (PDE-5i) in reducing hemocompatibility-related events in LVAD patients.
  • To evaluate the impact of PDE-5i on mortality, ischemic stroke, pump thrombosis, and gastrointestinal bleeding.
  • To synthesize current evidence on PDE-5i as a potential adjunctive therapy for LVAD recipients.

Main Methods:

  • Systematic review and meta-analysis of studies retrieved from Pubmed, Scopus, and CENTRAL (1990-2022).
  • Inclusion of 15 studies for qualitative synthesis and 9 studies for quantitative synthesis.
  • Utilized a fixed-effects model for meta-analysis due to a small number of studies; primary endpoint was all-cause mortality, secondary endpoints included ischemic stroke, pump thrombosis, and gastrointestinal bleeding.

Main Results:

  • Phosphodiesterase-5 inhibitors (PDE-5i) were associated with significantly lower all-cause mortality (OR: 0.92 [95% CI: 0.85, 0.98]; p = 0.02).
  • Reduced incidence of ischemic stroke (OR: 0.87 [95% CI: 0.78, 0.98]; p = 0.02) and pump thrombosis (OR: 0.90 [95% CI: 0.82, 0.99]; p = 0.04) observed in the PDE-5i group.
  • A significantly higher incidence of gastrointestinal bleeding was noted in patients receiving PDE-5i (OR: 1.26 [95% CI: 1.11, 1.44]; p < 0.01).

Conclusions:

  • Post-implant use of PDE-5i in LVAD patients demonstrates a benefit in reducing mortality and thrombotic complications.
  • The use of PDE-5i is associated with an increased risk of gastrointestinal bleeding, necessitating careful patient monitoring.
  • Further research may be warranted to balance the benefits and risks of PDE-5i in LVAD management.

Keywords:
bleedinghemocompatibilityleft ventricular assist devicesmeta-analysismortalityphosphodiesterase-5 inhibitorsthrombosis

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