Initial Experience with Sildenafil, Bosentan, and Nitric Oxide for Pediatric Cardiomyopathy Patients with Elevated Pulmonary Vascular Resistance before and after Orthotopic Heart Transplantation. (10th March 2010)

• Record Type: Journal Article
• Authors: Daftari, Babak; Alejos, Juan Carlos; Perens, Gregory
• Other Names: Zuckermann Andreas Academic Editor.
• Is Part Of: Journal of transplantation. Volume 2010(2010)
• Publication Date: 2010-03-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1155/2010/656984
• Languages: English
• ISSNs: 2090-0007

Abstract

Abstract : Background . Although pulmonary hypertension complicating dilated cardiomyopathy has been shown to be a significant risk factor for graft failure after heart transplantation, the upper limits of pulmonary vascular resistance (PVR) that would contraindicate pediatric heart transplantation are not known. Methods . A retrospective review of all pediatric orthotopic heart transplant (OHT) performed at our institution from 2002 to 2007 was performed. Seven patients with PVR> 6 Wood's units (WU) prior to transplant were compared pre- and postoperatively with 20 matched controls with PVR< 6 WU. All pulmonary vasodilator therapies used are described as well as outcomes during the first year posttransplant. Results . The mean PVR prior to transplantation in the 7 study cases was11.0 ± 4.6 (range 6–22) WU, compared to mean PVR of3.07 ± 0.9 WU (0.56–4.5) in the controls (P = .27 × 10 -6 ). All patients with elevated PVR were treated pre-OHT with either Sildenafil or Bosentan. Post-OHT, case patients received a combination of sildenafil, iloprost, and inhaled nitric oxide. All 7 case patients survived one year post-OHT, and there was no statistical difference between cases and controls for hospital stay, rejection/readmissions, or graft right ventricular failure. Mean PVR in the cases at one and three months post-OHT was not significantly different between the two groups. Only one of the cases required prolonged treatment with iloprost after OHT. Conclusions . A PVR above 6 WU should not be an absolute contraindication to heart transplantation in children.