Role of Oral Sildenafil in the Treatment of Right Ventricular Dysfunction After Heart Transplantation

ObjectiveRight ventricular dysfunction (RVD) after heart transplantation is a major complication, especially in patients with pulmonary hypertension (PH). Herein we have presented our initial experience with oral sildenafil for RVD following heart transplantation.Materials and MethodsFrom February 2006 to February 2008, 10 patients (7 males and 3 females) of overall mean age of 56.7 ± 9.5 years suffered from acute RVD immediately after heart transplantation. Preoperative hemodynamic data before and after a vasodilatation test (sodium nitroprusside; NTP) showed: systolic pulmonary arterial pressure (SPAP) 59.5 ± 12.9 and 44.2 ± 12.4 mm Hg; cardiac output (CO) 3.3 ± 0.9 and 3.7 ± 0.8 L/min; transpulmonary gradient (TPG) 11.7 ± 3.9 and 8.7 ± 3.6 mm Hg; and pulmonary vascular resistance (PVR) 3.9 ± 2.1 and 2.4 ± 1.3 wood units (WU), respectively. All patients required inotropes and inhaled nitric oxide (iNO) to be weaned from cardiopulmonary bypass (CPB).ResultsIntravenous (IV) or inhaled vasodilators could be weaned using oral sildenafil in all patients. The hemodynamic data obtained during IV or inhaled drugs (between postoperative days 5 and 10) compared with those obtained on sildenafil therapy alone (about 1 month after transplantation) showed a significant decrease in SPAP (39.0 ± 8.2 vs 32.0 ± 6.5 mm Hg; P = .049).ConclusionThese data suggested that oral sildenafil may have a role in the treatment of RVD after heart transplantation.