Comment
Author: Admin | 2025-04-28
PVRI was higher in the sildenafil group (6.8 ± 3.9 indexed Woods units [WU]) as compared to the non-sildenafil group (2.5 ± 1.7 WU, p = 0.002). In the sildenafil group post-transplant, there were significant decreases in systolic pulmonary artery pressure, mean pulmonary artery pressure, trans-pulmonary gradient and PVRI (4.7 ± 2.9 WU before sildenafil initiation to 2.7 ± 1 WU on sildenafil, p = 0.0007). While intubation time, length of inotrope use and time to hospital discharge were longer in the sildenafil group, survival was similar between both groups. Oral sildenafil was associated with a significant improvement in right ventricular dysfunction and invasive hemodynamic measurements in pediatric heart transplant recipients with high PVRI early after transplant.An UpToDate review on “Heart transplantation in adults: Prognosis” (Pham, 2023) does not mention sildenafil as a management option.Combination (Dual / Triple) PharmacotherapyDual pharmacotherapy (agents with different mechanisms of action) for the treatment of members with WHO Class II to IV pulmonary arterial hypertension (PAH) should be considered when criteria listed above are met; triple pharmacotherapy (agents with different mechanisms of action) for the treatment of PAH should be reviewed on an individual case basis.The American College of Chest Physicians (CHEST) guideline’s on “Pharmacologic therapy for pulmonary arterial hypertension in adults” (Taichman et al, 2014) stated that “For treatment naive pulmonary arterial hypertension (PAH) patients in World Health Organization [WHO] functional class [FC] IV who are unable or do not desire to manage parenteral prostanoid therapy, the panel advises treatment with an inhaled prostanoid in combination with an endothelin receptor antagonists (ETRA) (e.g., bosentan, ambrisentan, macitentan)”.Zijlstra et al (2014) stated that in order to describe survival and treatment strategies in pediatric PAH in the current era of PAH-targeted drugs and to identify predictors of outcome, these investigators studied uniformly defined contemporary patient cohorts at
Add Comment