Therapeutic potential of sildenafil in patients with chronic heart failure after cardiac surgery

BackgroundPrevious studies have demonstrated hemodynamic and clinical benefits associated with chronic inhibition of 5-phosphodiesterase with sildenafil therapy for heart failure patients. However, its effects in refractory heart failure following cardiac surgery are unknown.ObjectiveTo evaluate the clinical benefits of sildenafil addition to standard therapy in patients with advanced (refractory) heart failure after cardiac surgery.MethodsA prospective single-arm study which was done on 26 patients with refractory heart failure after cardiac surgery despite receiving the standard anti-failure treatment, from September 2012 to June 2013. Patients were included into one group and were evaluated before and after 1, 2 and 3 months of sildenafil addition to the standard anti-failure treatment.ResultsAdd-on sildenafil treatment resulted in significant increase in cardiac output, ejection fraction and fractional shortening, with significant decrease in left ventricular systolic internal diameter, end systolic volume, right ventricular pressure and pulmonary hypertension. Consistently, there were significant improvements in signs and symptoms of heart failure, New York Heart Association Class, with marked improvement in the patients' clinical status. There were no significant changes in heart rate, left ventricular diastolic internal diameter and end diastolic volume. There were no significant adverse events and the reported four cases of mortality (15.4%) were died due to different causes and none was associated with sildenafil therapy.ConclusionWe demonstrated that sildenafil use improves signs and symptoms of heart failure, NYHA class, echocardiographic parameters and quality of life in patients with refractory heart failure following cardiac surgery.