title: Treatment of secondary pulmonary hypertension with bosentan after left ventricular assist device implantation.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Shane J
authors.initials: SJ
authors.lastname: LaRue
authors.forename: Rafael
authors.initials: R
authors.lastname: Garcia-Cortes
authors.forename: Michael E
authors.initials: ME
authors.lastname: Nassif
authors.forename: Justin M
authors.initials: JM
authors.lastname: Vader
authors.forename: Shuddhadeb
authors.initials: S
authors.lastname: Ray
authors.forename: Ashwin
authors.initials: A
authors.lastname: Ravichandran
authors.forename: Ravi
authors.initials: R
authors.lastname: Rasalingham
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Wang
authors.forename: Joel D
authors.initials: JD
authors.lastname: Schilling
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000187:drug effects*; D000077300:Bosentan; D065128:Endothelin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000187:drug effects* / Q000503:physiopathology; D012189:Retrospective Studies; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D065128:Endothelin Receptor Antagonists; D013449:Sulfonamides; D000077300:Bosentan
keywords: Bosentan; Pulmonary vasodilator; Secondary pulmonary hypertension; Ventricular assist device