Conflict of interest: None.
Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation
Version of Record online: 1 AUG 2012
© 2012 John Wiley & Sons A/S
Volume 27, Issue 1, pages 25–31, January–February 2013
How to Cite
Perez-Villa F, Farrero M, Cardona M, Castel MA, Tatjer I, Penela D, Vallejos I. Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.
- Issue online: 28 JAN 2013
- Version of Record online: 1 AUG 2012
- Manuscript Accepted: 16 MAY 2012
- heart transplantation;
- pulmonary hypertension
Increased pulmonary vascular resistance (PVR) is associated with increased right ventricular failure and mortality after heart transplantation.
In this prospective study, 22 patients considered high-risk candidates for heart transplantation because of severe pulmonary hypertension (PVR = 6 ± 2 Wood units; transpulmonary gradient 22 ± 7 mmHg), received bosentan 125 mg bid. Right heart catheterization was repeated after four months (n = 22) and 12 months (n = 9). Eleven patients who declined participation in the study were considered as control group.
After four months, PVR decreased by 38% in patients receiving bosentan (n = 22), while it increased by 25% in the control group (p = 0.001). Those patients who received bosentan for 12 months (n = 9), experienced a 60% reduction in PVR compared to baseline (p = 0.003). Only three patients (14%) had no hemodynamic improvement with bosentan. After bosentan therapy, 14 patients (64%) underwent heart transplantation. Patients with high PVR who received bosentan showed a trend toward better one-yr survival after transplantation than patients with PVR ≤ 2.5 Wood units transplanted in the same period of time (93% vs. 83%).
In patients considered high-risk candidates for heart transplantation because of high PVR, therapy with bosentan is associated with a significant reduction in PVR and a good outcome after transplantation.