Veraprapas Kittipibul1, Vanessa Blumer2, Natthapon Angsubhakorn3, Gabriel A Hernandez4, Sandra Chaparro5, Ryan J Tedford6, Richa Agarwal7. 1. Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL. 2. Division of Cardiology, Duke University Medical Center, Durham, NC. 3. Department of Medicine, University of Minnesota, Minneapolis, MN. 4. Division of Cardiology, University of Mississippi Medical Center, Jackson, MS. 5. Advanced Heart Failure Program, Baptist Health South Florida, Miami, FL. 6. Division of Cardiology, Medical University of South Carolina, Charleston, SC. 7. Division of Cardiology, Duke University Medical Center, Durham, NC. Electronic address: richa.agarwal@duke.edu.
Abstract
BACKGROUND: Phosphodiesterase-5 Inhibitors (PDE5i) have been used to treat pulmonary hypertension and right ventricular failure (RVF) in patients with left ventricular assist devices (LVAD). Effects of PDE5i on post-LVAD outcomes including hemocompatibility-related adverse events (HRAE) are not well established. OBJECTIVE: This systematic review and meta-analysis aims to evaluate the effects of PDE5i on post-LVAD outcomes. METHODS: A comprehensive literature search was conducted using Pubmed and Embase databases from inception through November 25, 2020 to compare post-LVAD outcomes in patients with or without PDE5i use. Pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic were calculated. RESULTS: Thirteen observational studies were included in this analysis. Use of PDE5i was not significantly associated with lower postoperative RVF (OR 0.38, 95%CI 0.02-5.96, p=0.41). There was no significant association between PDE5i and gastrointestinal (GI) bleeding (OR 1.23, 95%CI 0.76-1.98, p=0.2), overall stroke (OR 0.60, 95%CI 0.21-1.68, p=0.17), ischemic stroke (OR 0.61, 95%CI 0.09-4.07, p=0.38), and pump thrombosis (OR 0.71, 95%CI 0.14-3.54, p=0.46). CONCLUSIONS: Our meta-analysis showed no significant association between PDE5i and post-LVAD RVF. Despite the anti-platelet effects of PDE5i, there was no significant association between PDE5i and GI bleeding, overall stroke, ischemic stroke, and pump thrombosis. Randomized-controlled studies are warranted to evaluate the net benefits or harms of PDE5i in LVAD population.
BACKGROUND: Phosphodiesterase-5 Inhibitors (PDE5i) have been used to treat pulmonary hypertension and right ventricular failure (RVF) in patients with left ventricular assist devices (LVAD). Effects of PDE5i on post-LVAD outcomes including hemocompatibility-related adverse events (HRAE) are not well established. OBJECTIVE: This systematic review and meta-analysis aims to evaluate the effects of PDE5i on post-LVAD outcomes. METHODS: A comprehensive literature search was conducted using Pubmed and Embase databases from inception through November 25, 2020 to compare post-LVAD outcomes in patients with or without PDE5i use. Pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic were calculated. RESULTS: Thirteen observational studies were included in this analysis. Use of PDE5i was not significantly associated with lower postoperative RVF (OR 0.38, 95%CI 0.02-5.96, p=0.41). There was no significant association between PDE5i and gastrointestinal (GI) bleeding (OR 1.23, 95%CI 0.76-1.98, p=0.2), overall stroke (OR 0.60, 95%CI 0.21-1.68, p=0.17), ischemic stroke (OR 0.61, 95%CI 0.09-4.07, p=0.38), and pump thrombosis (OR 0.71, 95%CI 0.14-3.54, p=0.46). CONCLUSIONS: Our meta-analysis showed no significant association between PDE5i and post-LVAD RVF. Despite the anti-platelet effects of PDE5i, there was no significant association between PDE5i and GI bleeding, overall stroke, ischemic stroke, and pump thrombosis. Randomized-controlled studies are warranted to evaluate the net benefits or harms of PDE5i in LVAD population.
Authors: Luca Monzo; Adrian Reichenbach; Hikmet Al-Hiti; Ivana Jurcova; Zuzana Huskova; Josef Kautzner; Vojtech Melenovsky Journal: Front Cardiovasc Med Date: 2022-05-26
Authors: E Wilson Grandin; Gaurav Gulati; Jose I Nunez; Kevin Kennedy; J Eduardo Rame; Pavan Atluri; Francis D Pagani; James K Kirklin; Robert L Kormos; Jeffrey Teuteberg; Michael S Kiernan Journal: Circ Heart Fail Date: 2022-03-25 Impact factor: 10.447