| Popis: |
Introduction: The presence Pulmonary Hypertension (PH) in the pre-transplant evaluation period, had an increase in morbidity and mortality following heart transplant, secondary to right ventricular failure; however, in recent years it has been shown that the presence of PH while still reversible does not appear to be associated with this increase risk. The aim of this work is to study the efficacy and safety of sildenafil in order to evaluate the reversibility of PH associated with CHF in heart transplant candidates in relation to the clinical outcome after surgery. Methods and Results: Included were all heart transplant patients with PH who had previously undergone an acute vasodilator test and then chronic treatment with sildenafil, and the morbidity and mortality of these patients were compared to those of heart transplant patients without prior PH. Between September 2001 and April 2010, 165 orthotopic transplants were performed, 31 of these patients had out of proportion PH and 134 of them not. Patients with PH underwent an acute vasodilator test and then chronic treatment with sildenafil. There were no statistically significant differences observed in the subsequent evolution of the PH group vs. the non-PH group in terms of total mortality (22.6% vs. 24.6%), in-hospital mortality (6.5% vs. 8.2%), days in ICU (3-7 d vs. 4-7 d), need for vasoactive drugs (1-3 d vs. 1-4 d), need for counterpulsation balloon pump (53.4% vs. 46.4%) or need for hemodiafiltration (4.5% vs. 7%). Conclusion: In patients with out of proportion PH associated with CHF in pre-transplant evaluation, a positive response to the acute vasodilator test with sildenafil predicts mortality and morbidity similar to that of heart transplant patients with no prior PH. |
