• M Lopez-Meseguer, C Berastegui, V Monforte, C Bravo, E Domingo, and A Roman.
• Respiratory Department, Institute of Research, Hospital Universitari Vall d'Hebron, Universitat Autònoma of Barcelona, Barcelona, Spain.
• Transplant. Proc. 2013 Jul 1; 45 (6): 2347-50.

BackgroundAccepted treatment for severe pulmonary arterial hypertension (PAH) includes intravenous epoprostenol and lung transplantation (LT). Inhaled iloprost plus oral sildenafil (Ilo-Sil) is an alternative strategy that may also delay the need for LT.Patients And MethodsThis was a long-term descriptive study in eight patients with PAH functional class (FC) IV with right heart failure, four of them potential candidates for LT, who were treated with Ilo-Sil as an alternative to epoprostenol.ResultsAt the start of the study, patients (seven women; mean age, 43.8 [range, 34-66] years) were in FC IV and unable to perform the 6-minute walk test. Mean cardiac index was 1.9 (range, 1.4-2.1) L/min/m(2). Treatment with Ilo-Sil provoked a rapid and sustained improvement; mean walking distance at 3 months was 322 ± 90 m and no patient remained in FC IV. Survival at 1 and 5 years was 100% and 75%, respectively. Of the four potential LT candidates, one underwent transplantation after 6.8 years and one died after 1.2 years.ConclusionsThese results suggest that therapy with Ilo-Sil represents an acceptable alternative in patients with severe and unstable PAH.Copyright © 2013. Published by Elsevier Inc.

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