PROSTACYCLIN (EPOPROSTENOL) AND HEART-LUNG TRANSPLANTATION AS TREATMENTS FOR SEVERE PULMONARY-HYPERTENSION

Objective-To determine whether epoprostenol (prostacyclin, PGI2) or he art-lung transplantation (HLT), or both improves survival of patients with severe pulmonary hypertension. Design-This was a prospective stud y where the effects of epoprostenol were compared with conventional tr eatment. Also, the benefits of epoprostenol and HLT were assessed by c omparing survival in this group with that of 120 patients at the Mayo Clinic before HLT and epoprostenol treatment became available. Patient s and interventions-Forty four patients were studied; 25 received cont inuous epoprostenol over a four year period (mean (SD) cardiac index 1 .8 (0.4) 1 min-1 m-2 and mean (SD) pulmonary artery pressure (PAP) 70 (16) mm Hg) and 19 did not (cardiac index 2.1 (0.6) 1 min-1 m-2 and PA P 64 (13) mm Hg). Ten patients underwent HLT: seven had received epopr ostenol, and three had not. Results-The therapeutic intervention with epoprostenol, or HLT, or both improved survival compared with the Mayo clinic patients (p = 0.05). Most of the benefit was conferred by epop rostenol, which prolonged survival twofold from a median time of eight to 17 months and doubled the chances of successful HLT. The improved survival with epoprostenol was not related to its immediate capacity t o cause pulmonary vasodilation. Those patients who had limited acute p ulmonary vasodilation when treated with epoprostenol showed the greate st improvement in survival. Conclusions-These preliminary results indi cate that those pulmonary hypertensive patients with the poorest chanc e of survival can be helped by epoprostenol and by HLT.