Centro Hospitalar e Universitario de Coimbra EPE, Coimbra - Portugal.
Arq Bras Cardiol. 2021 Feb;116(2):219-226. doi: 10.36660/abc.20190047.
Elevated pulmonary vascular resistance remains a major problem for heart transplant (HT) candidate selection.
This study sought at assess the effect of pre-HT sildenafil administration in patients with fixed pulmonary hypertension.
This retrospective, single-center study included 300 consecutive, HT candidates treated between 2003 and 2013, in which 95 patients had fixed PH, and of these, 30 patients were treated with sildenafil and eventually received a transplant, forming Group A. Group B included 205 patients without PH who underwent HT. Pulmonary hemodynamics were evaluated before HT, as well as 1 week after and 1 year after HT. Survival was compared between the groups. In this study, a p value < 0.05 was considered statistically significant.
After treatment with sildenafil but before HT, PVR (-39%) and sPAP (-10%) decreased significantly. sPAP decreased after HT in both groups, but it remained significantly higher in group A vs. group B (40.3 ± 8.0 mmHg vs 36.5 ± 11.5 mmHg, p=0.022). One year after HT, sPAP was 32.4 ± 6.3 mmHg in group A vs 30.5 ± 8.2 mmHg in group B (p=0.274). The survival rate after HT at 30 days (97% in group A versus 96% in group B), at 6 months (87% versus 93%) and at one year (80% vs 91%) were not statistically significant (Log-rank p=0.063). After this first year, the attrition rate was similar among both groups (conditional survival after 1 year, Log-rank p=0.321).
In patients with severe PH pre-treated with sildenafil, early post-operative hemodynamics and prognosis are numerically worse than in patients without PH, but after 1 year, the medium to long-term mortality proved to be similar. (Arq Bras Cardiol. 2021; 116(2):219-226).
肺血管阻力升高仍然是心脏移植（HT）候选者选择的主要问题。
本研究旨在评估 HT 前给予西地那非对固定性肺动脉高压患者的影响。
这是一项回顾性、单中心研究，纳入了 2003 年至 2013 年间接受 HT 的 300 例连续患者，其中 95 例患者为固定 PH，其中 30 例患者接受了西地那非治疗并最终接受了移植，组成 A 组。B 组包括 205 例无 PH 的患者接受 HT。在 HT 前、HT 后 1 周和 1 年后评估肺血流动力学。比较两组的存活率。在本研究中，p 值 < 0.05 被认为具有统计学意义。
西地那非治疗后但在 HT 前，PVR（-39%）和 sPAP（-10%）显著降低。两组患者 HT 后 sPAP 均下降，但 A 组仍显著高于 B 组（40.3 ± 8.0 mmHg 比 36.5 ± 11.5 mmHg，p=0.022）。HT 后 1 年，A 组 sPAP 为 32.4 ± 6.3 mmHg，B 组为 30.5 ± 8.2 mmHg（p=0.274）。HT 后 30 天（A 组 97%，B 组 96%）、6 个月（A 组 87%，B 组 93%）和 1 年（A 组 80%，B 组 91%）的存活率无统计学意义（Log-rank p=0.063）。在这一年之后，两组的失效率相似（1 年后条件生存率，Log-rank p=0.321）。
在接受 HT 前接受西地那非预处理的严重 PH 患者中，术后早期血流动力学和预后在数值上差于无 PH 的患者，但 1 年后，中至长期死亡率相似。（Arq Bras Cardiol. 2021; 116(2):219-226）。
