Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation

Shane J. Larue, Rafael Garcia-Cortes, Michael E. Nassif, Justin M. Vader, Shuddhadeb Ray, Ashwin Ravichandran, Ravi Rasalingham, Scott C. Silvestry, Gregory A. Ewald, I. Wen Wang, Joel D. Schilling

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)50-55
Number of pages6
JournalCardiovascular Therapeutics
Volume33
Issue number2
DOIs
StatePublished - Apr 1 2015

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Keywords

  • Bosentan
  • Pulmonary vasodilator
  • Secondary pulmonary hypertension
  • Ventricular assist device

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Larue, S. J., Garcia-Cortes, R., Nassif, M. E., Vader, J. M., Ray, S., Ravichandran, A., Rasalingham, R., Silvestry, S. C., Ewald, G. A., Wang, I. W., & Schilling, J. D. (2015). Treatment of Secondary Pulmonary Hypertension with Bosentan after Left Ventricular Assist Device Implantation. Cardiovascular Therapeutics, 33(2), 50-55. https://doi.org/10.1111/1755-5922.12111