Right-Sided Heart Failure May Increase with Pre-Treatment Drug Regimen

Sara Karlovitch, Editorial Intern
Published Online: Tuesday, June 11th, 2019
Pretreatment with off-label selective vasodilator drugs prior to the implantation of left-ventricle assist devices (LVAD) may increase the chance of right-sided heart failure, according to a study published in the American Heart Association’s journal Circulation: Heart Failure. 
Approximately 10% to 40% of patients who undergo a LVAD implantation for left-sided heart failure develop right-sided heart failure. In order to avoid this serious complication physicians may prescribe phosphodiesterase- 5 inhibitors (PDE5i). Several small-scale studies showed PDE5i drugs, which dilate the pulmonary artery, to have possible benefits. However, this off-label approach was never affirmed. 
“We found no benefit of this therapy in patients receiving LVAD deceives, including patients with pulmonary vascular disease or right ventricular dysfunction—the very patients who might be expected to benefit the most,” the senior investigator and cardiologist at Tufts Medical Center Michael Kiernan, MD, MS, said in the press release.   
In the largest study to date, investigators analyzed approximately 11,544 individuals who received a LVAD in the United States between 2012 to 2017 and found that 24% of those studied experienced right-sided heart failure.  
Investigators also found no benefit of pretreatment with PDE5i drugs for patients receiving left-ventricular assist devices. In the group that received the pre-treatment, 29% developed right-sided heart failure. Those who received the PDE5i drugs also experienced bleeding within a week of implantation at a rate of 46% higher than those who did not receive the drugs.   
“Our findings should give pause to clinicians considering this therapy, and we caution against routine use of these therapies prior to LVAD surgery,” Kiernan said.   
  1. Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices [press release]. American Heart Association pressroom. Published June 11, 2019. https://newsroom.heart.org/news/preventive-drug-therapy-may-increase-right-sided-heart-failure-risk-in-patients-who-receive-heart-devices?preview=d409. Accessed June 11, 2019.

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