Nehal Gheewala, DO

https://nsuworks.nova.edu/cnso_alumni/1112/thumbnail.jp

HEMODYNAMIC EFFECTS OF SILDENAFIL ON RIGHT HEART FUNCTION IN LEFT VENTRICULAR DEVICES

Background: Right ventricular failure (RVF) is the leading cause of morbidity and mortality for patients with a left ventricular assist device (LVAD). There is limited data to support lowering pulmonary pressure with a phosphodiesterase inhibitor to improve right ventricular function. This study aims to evaluate the hemodynamic effects of sildenafil on right heart function in LVAD patients. Methods: This was a single center, retrospective, cohort study comparing LVAD patients on sildenafil versus those who were not (control group). Patients who received a LVAD from January 2010 to December 2015 were included in the study. Primary endpoint was right heart function at 1, 6, and 12 months post-LVAD implantation. Secondary endpoints include changes in CVP, PCWP, PAPs/d/m, LVEDD, TAPSE, FAC and dosage of sildenafil. Right heart failure was defined as CVP \u3e 20 and CVP:PCWP \u3e 0.63. Hemodynamic parameters are collected by manual review of echocardiograms for each patient at baseline, 1 month, 6 months and 12 months post-LVAD placement. Results: 168 patients were included in the analysis, of which 62 received sildenafil and 106 did not. The mean age was 55 ± 13. Heartmate II was the most common LVAD (82%). There were no differences in RVF at baseline (6.7 vs 4.9%, p = 0.726) and at 1 month (3.8 vs 4.2%, p = 1.00). There were no occurrences of RVF at 6 and 12 months in either group. Baseline CVP (mmHg) and PCWP (mmHg) were higher in the sildenafil group compared to control group (CVP 11 [6,21.8] vs 9 [6,18], p = 0.036; PCWP 24 [19.25,31] vs 19[15,24], p = 0.001), respectively. No difference was noted in CVP or PCWP between groups up to 12 months postLVAD. PAPs/d were higher at baseline and at 1 month in the sildenafil group but no differences at 6 and 12-month. PAPm at baseline was higher in sildenafil (38.5 [35,43.75] vs 32 [25.75,36], p \u3c 0.001) and at 1 month (26.5 [22.25,34.25] vs 18 [14.5,24.5], p = 0.002). No differences were noted between groups in FAC, TAPSE, and LVEDD. Conclusion: There were no differences observed in the incidence of RVF up to 12 months post-LVAD placement between patients who received sildenafil and those who did not. Sildenafil does not appear to have a significant effect on hemodynamic parameters in patients with LVAD