Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.

Abstract:

BACKGROUND:Increased pulmonary vascular resistance (PVR) is associated with increased right ventricular failure and mortality after heart transplantation. METHODS:In this prospective study, 22 patients considered high-risk candidates for heart transplantation because of severe pulmonary hypertension (PVR = 6 ± 2 Wood units; transpulmonary gradient 22 ± 7 mmHg), received bosentan 125 mg bid. Right heart catheterization was repeated after four months (n = 22) and 12 months (n = 9). Eleven patients who declined participation in the study were considered as control group. RESULTS:After four months, PVR decreased by 38% in patients receiving bosentan (n = 22), while it increased by 25% in the control group (p = 0.001). Those patients who received bosentan for 12 months (n = 9), experienced a 60% reduction in PVR compared to baseline (p = 0.003). Only three patients (14%) had no hemodynamic improvement with bosentan. After bosentan therapy, 14 patients (64%) underwent heart transplantation. Patients with high PVR who received bosentan showed a trend toward better one-yr survival after transplantation than patients with PVR ≤ 2.5 Wood units transplanted in the same period of time (93% vs. 83%). CONCLUSIONS:In patients considered high-risk candidates for heart transplantation because of high PVR, therapy with bosentan is associated with a significant reduction in PVR and a good outcome after transplantation.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Perez-Villa F,Farrero M,Cardona M,Castel MA,Tatjer I,Penela D,Vallejos I

doi

10.1111/j.1399-0012.2012.01689.x

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

25-31

issue

1

eissn

0902-0063

issn

1399-0012

journal_volume

27

pub_type

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