Long-Term Clinical and Hemodynamic Outcomes after Heart Transplantation in Patients Pre-Treated with Sildenafil

Abstract Background Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection. Objective This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension. Methods This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant. Results After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321). Conclusion In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226)

摘要
研究背景：肺血管阻力升高仍是心脏移植（heart transplant, HT）候选者筛选的主要难题。
研究目的：本研究旨在评估术前给予西地那非对固定性肺动脉高压（pulmonary hypertension, PH）患者的治疗效果。
研究方法：本研究为单中心回顾性研究，纳入2003年至2013年间收治的300例连续性心脏移植候选者，其中95例确诊固定性肺动脉高压；该95例患者中，30例接受西地那非治疗并最终完成心脏移植，设为A组。B组纳入205例无肺动脉高压且接受心脏移植的患者。分别于心脏移植术前、术后1周及术后1年评估肺血流动力学指标，并比较两组患者的生存率。本研究以P值<0.05为差异具有统计学意义。
研究结果：西地那非治疗后、心脏移植术前，患者的肺血管阻力（pulmonary vascular resistance, PVR）下降39%，收缩期肺动脉压（systolic pulmonary artery pressure, sPAP）下降10%，两项指标均显著降低。两组患者术后收缩期肺动脉压均有所下降，但A组仍显著高于B组（40.3±8.0 mmHg vs 36.5±11.5 mmHg，p=0.022）。心脏移植术后1年，A组收缩期肺动脉压为32.4±6.3 mmHg，B组为30.5±8.2 mmHg（p=0.274）。两组患者心脏移植术后30天生存率（A组97% vs B组96%）、6个月生存率（87% vs 93%）及1年生存率（80% vs 91%）均无统计学差异（Log-rank检验p=0.063）。术后第一年之后，两组患者的病死率无显著差异（1年后条件生存率，Log-rank检验p=0.321）。
研究结论：对于术前接受西地那非治疗的重度肺动脉高压患者，术后早期血流动力学状态及预后情况在数值上差于无肺动脉高压患者，但术后1年的中长期死亡率无显著差异。（发表于Arq Bras Cardiol. 2021; 116(2):219-226）