Abstract 13680: Assessing the Role of Phosphodiesterase-5 Inhibitors in the Management of Left Ventricular Assist Device Patients: A Systematic Review and Meta-Analysis

Abstract

Introduction: The advent of left ventricular assist device (LVAD) therapy revolutionized the management of severe heart failure. Right ventricular failure (RVF) remains a principal cause of mortality among these patients. Previous reports suggest phosphodiesterase-5 inhibitors (PDE-5is) can decrease pulmonary pressure, enhance ventricular function, and lower the risk of thrombosis and stroke. Nonetheless, certain studies present conflicting data, indicating potential increases in bleeding and mortality among patients using PDE-5is. Hypothesis: This study aimed to assess the outcomes of LVAD patients who were administered PDE-5is. Methods: A comprehensive search of PubMed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature was conducted until January 2022. We included studies that directly compared outcomes of LVAD patients who used PDE-5is versus those who did not. Primary outcomes focused on postoperative RVF and all-cause mortality, while secondary outcomes included stroke, gastrointestinal bleeding, and pump thrombosis. The statistical analysis was performed using "R" statistical computing software (version 4), utilizing the metafor and meta packages. Results: Eight studies encompassing 3035 PDE-5i users and 3023 non-users were included in our analysis. PDE-5i use was not significantly associated with postoperative RVF (RR: 0.84; 95% CI 0.58-1.21, P=0.35; I2 = 83.2%). Similarly, there was no significant correlation between PDE-5i use and all-cause mortality (RR: 0.99; 95% CI 0.96-1.02, P=0.75; I2 = 0%), pump thrombosis (RR: 0.66; 95% CI 0.61-0.72, P=0.45; I2 = 0%), stroke (RR: 0.96; 95% CI 0.84-1.08, P=0.58; I2 = 0%), or gastrointestinal bleeding (RR: 1.13; 95% CI 0.77-1.67, P=0.65; I2 = 0%). Conclusions: Our analysis suggests that PDE-5i use is not associated with increased adverse outcomes such as bleeding, stroke, thrombosis, or all-cause mortality in LVAD patients. However, given the heterogeneity of the included studies and a lack of robust evidence supporting PDE-5i use, high-quality randomized controlled trials are needed to assess the potential benefits, efficacy, and safety of PDE-5is in reducing RVF, thrombosis, and all-cause mortality in LVAD patients.