Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation

被引:24
作者
LaRue, Shane J. [1 ]
Garcia-Cortes, Rafael [1 ]
Nassif, Michael E. [1 ]
Vader, Justin M. [1 ]
Ray, Shuddhadeb [2 ]
Ravichandran, Ashwin [1 ]
Rasalingham, Ravi [1 ]
Silvestry, Scott C. [2 ]
Ewald, Gregory A. [1 ]
Wang, I-Wen [3 ]
Schilling, Joel D. [1 ,4 ]
机构
[1] Washington Univ, Sch Med, Div Cardiol, St Louis, MO 63110 USA
[2] Washington Univ, Sch Med, Div Cardiothorac Surg, St Louis, MO 63110 USA
[3] Indiana Univ Hlth, Div Cardiovasc & Thorac Surg, Indianapolis, IN USA
[4] Washington Univ, Sch Med, Dept Pathol & Immunol, St Louis, MO 63110 USA
基金
美国国家卫生研究院;
关键词
Bosentan; Pulmonary vasodilator; Secondary pulmonary hypertension; Ventricular assist device; MECHANICAL CIRCULATORY SUPPORT; RIGHT HEART-FAILURE; ARTERY PRESSURE; TRANSPLANTATION; MORTALITY;
D O I
10.1111/1755-5922.12111
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IntroductionSecondary pulmonary hypertension (PH) and right ventricular dysfunction are common and associated with poor prognosis in HF patients with left ventricular assist devices (LVADs). The role of pulmonary vasodilator therapy for these patients is currently unclear. AimsWe sought to evaluate the safety and clinical course of patients treated with bosentan, an endothelin receptor antagonist, after the implementation of a LVAD. ResultsBetween 10/2008 and 5/2011, 50 consecutive patients with mean PAP >25mmHg were treated with bosentan after LVAD implantation for a mean duration of 15.7 (12.4) months. Ten patients discontinued the drug for possible side effects, including three for LFT abnormalities. Comparison of baseline to 6-month follow-up data revealed laboratory evidence for decongestion with a decrease in bilirubin (2.3-0.6, P<0.0001) and an improvement in pulmonary hemodynamics with echocardiographically calculated mean PVR decreasing 1.4 woods units (3.93 +/- 1.53 to 2.58 +/- 1.05, P<0.0001). ConclusionIn this single-centered retrospective case series, we provide evidence that the tolerability of bosentan in LVAD-supported patients with secondary PH is comparable to prior experience in patients with heart failure.
引用
收藏
页码:50 / 55
页数:6
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