Background: Right ventricular (RV) dysfunction is a serious complication that may occur after cardiac transplant and result in graft failure or death. Inotropes (i.e., epinephrine, milrinone) and inhaled vasodilators (i.e., nitric oxide, epoprostenol) are typically used as treatment but may not provide adequate or durable response in all patients. To date, only case reports suggest oral sildenafil, a phosphodiesterase-5 inhibitor, may be useful as adjuvant therapy in these patients. Our center has been using sildenafil as adjuvant therapy in this patient population since 2002. We examined if there was a difference in early versus late initiation of sildenafil on pulmonary pressures and RV dysfunction in post-cardiac transplant surgery patients.

Methods: A retrospective chart review was performed on all adult patients who received sildenafil for >48 hours post-cardiac transplant at a tertiary care center between 2002 and 2012. Patients were categorized into two groups based on time of sildenafil initiation post-transplant: early initiation (EI; within 72 hours) or late initiation (LI; ≥72 hours). The primary outcome measures were proportions of patients with pulmonary hypertension or right ventricular dysfunction at 1 week and the total duration of inotrope and inhaled vasodilator therapy. Tests for statistical significance included Wilcoxon-Mann-Whitney for continuous variables, and Chi-squared tests for categorical data (two-tailed; p values ≤0.05 considered statistically significant). Linear regression analysis was performed to identify variables associated with increased duration of inotrope/vasodilator use.

Results: We identified 80 patients, with 48 (60%) in EI group and 32 (40.0%) in LI group. There was no difference in PH or RV dysfunction in the two groups at 1 week, however, the duration of IV inotrope and inhaled vasodilator therapy was shorter in the EI group. Linear regression found, for each day sildenafil initiation was delayed, there was an associated increase in the total duration of IV inotrope and inhaled vasodilator therapy of 16.8 hours [95% CI: 10.3 to 23.3, p<0.001].

Conclusions: There was no significant difference in PH and RV dysfunction between the EI and LI groups; however, early initiation of sildenafil in post-cardiac transplant patients was associated with a decreased total duration of inotrope and inhaled vasodilator use and may result in cost-savings.

CITATION INFORMATION: Brown P, Hamandi B, McDonald M, Ahmed H, Whitty R, Lowe D. Retrospective Review of Early versus Late Initiation of Oral Sildenafil for Right Ventricular Dysfunction in Post-Cardiac Transplant Surgery Patients. Am J Transplant. 2017;17 (suppl 3).

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