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Evaluation of Clinical Outcomes with Phosphodiesterase-5 Inhibitor Therapy for Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation

Roberts, Katherine L.*; Shuster, Jerrica E.*; Britt, Nicholas S.*; Balsara, Keki R.; Graetz, Thomas J.; Helwani, Mohammad; Itoh, Akinobu; Tellor, Bethany R.*

doi: 10.1097/MAT.0000000000000809
Clinical Critical Care
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Few studies have evaluated the use of phosphodiesterase-5 inhibitors (PDE5-i) for right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation. The study purpose was to examine the impact of postoperative inpatient PDE5-i therapy on clinical outcomes in patients with LVADs. This single-center, retrospective cohort study screened 445 LVAD recipients between January 2011 and May 2015 for eligibility. Subjects receiving post-LVAD PDE5-i were compared with those who did not. The primary outcome was the proportion of all-cause hospital readmission at 30 days. Additional outcomes assessed included duration of intravenous inotrope or inhaled epoprostenol therapy, length of stay, duration of mechanical ventilation, overall survival, and improvement in the degree of postoperative RV dysfunction. Comparative analyses were performed before and after propensity score (PS) matching. Three-hundred and eighteen patients were included; 208 received post-LVAD inpatient PDE5-i and 110 patients did not. There was no difference in the rate of readmission at 30 days before or after PS matching. No significant differences were found between groups with regard to inotrope or epoprostenol duration, lengths of stay, duration of mechanical ventilation, overall survival, or improvement in the degree of RV dysfunction after PS matching. In the current study, the use of PDE5-i for adjunctive treatment of post-LVAD RV dysfunction was not associated with improved clinical outcomes.

From the *Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO

Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO

Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Washington University School of Medicine, St. Louis, MO.

Submitted for consideration January 2018; accepted for publication in revised form March 2018.

Presented, in-part, at the following professional meeting: International Society for Heart and Lung Transplantation Annual Meeting, April 7, 2017, San Diego, CA.

Correspondence: Katherine L. Roberts, Department of Pharmacy, Barnes-Jewish Hospital, 1 Barnes Jewish Hospital Plaza, Mailstop 90-52-411, Saint Louis, MO 63110. Email: katherine.roberts@bjc.org.

Copyright © 2019 by the American Society for Artificial Internal Organs