The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 346-351, August 2010

Bosentan induces clinical and hemodynamic improvement in candidates for right-sided heart bypass surgery

  • Keiichi Hirono, MD

      Affiliations

    • Department of Pediatrics, University of Toyama, Japan
    • ,
  • Naoki Yoshimura, MD

      Affiliations

    • First Department of Surgery, University of Toyama, Japan
    • ,
  • Masato Taguchi, PhD

      Affiliations

    • Department of Clinical Pharmacy, University of Toyama, Japan
    • ,
  • Kazuhiro Watanabe, MD

      Affiliations

    • Department of Pediatrics, University of Toyama, Japan
    • ,
  • Tsuneyuki Nakamura, MD

      Affiliations

    • Department of Pediatrics, Kanazawa Medical University, Kanazawa, Japan
    • ,
  • Fukiko Ichida, MD

      Affiliations

    • Department of Pediatrics, University of Toyama, Japan
    • Corresponding Author InformationAddress for reprints: Fukiko Ichida, MD, Department of Pediatrics, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930–0194 Japan.
    • ,
  • Toshio Miyawaki, MD

      Affiliations

    • Department of Pediatrics, University of Toyama, Japan

Received 2 November 2009; received in revised form 4 February 2010; accepted 21 March 2010. published online 03 May 2010.

Objective

To investigate the efficacy of bosentan in patients with single-ventricle physiology who were unable to undergo right-sided heart bypass surgery because of high pulmonary vascular resistance and pulmonary artery pressure.

Methods

Eight patients with single-ventricle physiology (2 male and 6 female; aged 7 months to 5 years, median 1 year) were enrolled. Prior surgical interventions included pulmonary artery banding in 4 patients, Blalock–Taussig shunt operation in 2 patients, and bidirectional Glenn operation in 5 patients. Right-sided heart bypass surgery was contraindicated for all patients because of high pulmonary vascular resistance and pulmonary artery pressure.

Results

Bosentan therapy successfully reduced pulmonary artery pressure and pulmonary vascular resistance in all patients. Mean pulmonary artery pressure at baseline and after bosentan therapy was 21.1 ± 7.2 mm Hg and 11.9 ± 4.1 mm Hg, respectively (P < .01). Mean pulmonary vascular resistance index at baseline and after bosentan therapy was 5.7 ± 3.3 U/m2 and 1.3 ± 0.4 U/m2, respectively (P < .01). Mean pulmonary vascular resistance/systemic vascular resistance at baseline and after bosentan therapy was 0.25 ± 0.11 and 0.07 ± 0.03, respectively (P < .01). All patients had improved clinical symptoms and underwent successful Fontan operations.

Conclusion

Bosentan induces mid-term clinical and hemodynamic improvement in patients with single-ventricle physiology and elevated pulmonary vascular resistance and pulmonary artery pressure. Bosentan therapy may increase the surgical options and improve outcomes in candidates for right-sided heart bypass surgery.

CTSNet classification: 16, 20

Abbreviations and Acronyms: CHD, congenital heart disease, NYUPHFI, New York University Pediatric Heart Failure Index, PAH, pulmonary artery hypertension, PAP, pulmonary artery pressure, PVR, pulmonary vascular resistance, SV, single ventricle

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 Disclosures: None.

PII: S0022-5223(10)00318-1

doi:10.1016/j.jtcvs.2010.03.023

The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 346-351, August 2010

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