Prostaglandin E-1 bridge to heart transplantation - methods, technique, results

Heart transplantation (HTx) candidates who remain severely symptomatic desp ite optimal therapy are normally hospitalized. Continuous infusion of intra venous drugs from a portable pump may allow such patients to live a fairly active life until a donor heart is found. Among the current potential bridg ing agents the synthetic beta-agonist dobutamine is preferred for inotropic support. Prostaglandin E1 (PGE1), a naturally occurring substance with an eicosanoid structure and potent pulmonary and systemic vasodilator action, is another candidate for this indication. It was shown in a double-blind tr ial that PGE1 lowers pre- and afterload in patients with left ventricular f ailure who are already stabilized on catecholamines. In addition, an open p ilot study of 54 patients suggested that chronic infusions with PGE1 at red uced dosages is a feasible and safe therapeutic approach to bridge end-stag e heart failure patients and may yield desirable effects in a subset of pat ients in the absence of intropic support with dobutamine. Meanwhile, we hav e demonstrated in a recent prospective randomized trial that PGE1 is superi or to dobutamine as a Single bridging drug with regard to improving event-f ree survival rates in this highrisk patient population.