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

J Thorac Cardiovasc Surg. 2010 Aug;140(2):346-51. doi: 10.1016/j.jtcvs.2010.03.023.

Abstract

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/m(2) and 1.3 +/- 0.4 U/m(2), 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.

Publication types

  • Clinical Trial

MeSH terms

  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Bosentan
  • Child, Preschool
  • Female
  • Fontan Procedure*
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / drug therapy*
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery
  • Hemodynamics / drug effects*
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / surgery
  • Infant
  • Male
  • Pulmonary Artery / drug effects*
  • Pulmonary Artery / physiopathology
  • Pulmonary Artery / surgery
  • Sulfonamides / adverse effects
  • Sulfonamides / therapeutic use*
  • Treatment Outcome
  • Vascular Resistance / drug effects

Substances

  • Antihypertensive Agents
  • Sulfonamides
  • Bosentan