TY - JOUR
T1 - Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation
AU - Larue, Shane J.
AU - Garcia-Cortes, Rafael
AU - Nassif, Michael E.
AU - Vader, Justin M.
AU - Ray, Shuddhadeb
AU - Ravichandran, Ashwin
AU - Rasalingham, Ravi
AU - Silvestry, Scott C.
AU - Ewald, Gregory A.
AU - Wang, I. Wen
AU - Schilling, Joel D.
N1 - Publisher Copyright:
© 2015 John Wiley and Sons Ltd.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Summary: Introduction: Secondary pulmonary hypertension (PH) and right ventricular dysfunction are common and associated with poor prognosis in HF patients with left ventricular assist devices (LVADs). The role of pulmonary vasodilator therapy for these patients is currently unclear. Aims: We sought to evaluate the safety and clinical course of patients treated with bosentan, an endothelin receptor antagonist, after the implementation of a LVAD. Results: Between 10/2008 and 5/2011, 50 consecutive patients with mean PAP >25 mmHg were treated with bosentan after LVAD implantation for a mean duration of 15.7 (±12.4) months. Ten patients discontinued the drug for possible side effects, including three for LFT abnormalities. Comparison of baseline to 6-month follow-up data revealed laboratory evidence for decongestion with a decrease in bilirubin (2.3-0.6, P < 0.0001) and an improvement in pulmonary hemodynamics with echocardiographically calculated mean PVR decreasing 1.4 woods units (3.93 ± 1.53 to 2.58 ± 1.05, P < 0.0001). Conclusion: In this single-centered retrospective case series, we provide evidence that the tolerability of bosentan in LVAD-supported patients with secondary PH is comparable to prior experience in patients with heart failure.
AB - Summary: Introduction: Secondary pulmonary hypertension (PH) and right ventricular dysfunction are common and associated with poor prognosis in HF patients with left ventricular assist devices (LVADs). The role of pulmonary vasodilator therapy for these patients is currently unclear. Aims: We sought to evaluate the safety and clinical course of patients treated with bosentan, an endothelin receptor antagonist, after the implementation of a LVAD. Results: Between 10/2008 and 5/2011, 50 consecutive patients with mean PAP >25 mmHg were treated with bosentan after LVAD implantation for a mean duration of 15.7 (±12.4) months. Ten patients discontinued the drug for possible side effects, including three for LFT abnormalities. Comparison of baseline to 6-month follow-up data revealed laboratory evidence for decongestion with a decrease in bilirubin (2.3-0.6, P < 0.0001) and an improvement in pulmonary hemodynamics with echocardiographically calculated mean PVR decreasing 1.4 woods units (3.93 ± 1.53 to 2.58 ± 1.05, P < 0.0001). Conclusion: In this single-centered retrospective case series, we provide evidence that the tolerability of bosentan in LVAD-supported patients with secondary PH is comparable to prior experience in patients with heart failure.
KW - Bosentan
KW - Pulmonary vasodilator
KW - Secondary pulmonary hypertension
KW - Ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84925358507&partnerID=8YFLogxK
U2 - 10.1111/1755-5922.12111
DO - 10.1111/1755-5922.12111
M3 - Article
C2 - 25759010
AN - SCOPUS:84925358507
SN - 1755-5914
VL - 33
SP - 50
EP - 55
JO - Cardiovascular Therapeutics
JF - Cardiovascular Therapeutics
IS - 2
ER -