LAUSR

BACKGROUND Phosphodiesterase-5 Inhibitors (PDE5i) have been used to treat pulmonary hypertension and right ventricular failure (RVF) in patients with left ventricular assist devices (LVAD). Effects of PDE5i on post-LVAD outcomes including hemocompatibility-related adverse events (HRAE) are not well established. OBJECTIVE This systematic review and meta-analysis aims to evaluate the effects of PDE5i on post-LVAD outcomes. METHODS A comprehensive literature search was conducted using Pubmed and Embase databases from inception through November 25, 2020 to compare post-LVAD outcomes in patients with or without PDE5i use. Pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic were calculated. RESULTS Thirteen observational studies were included in this analysis. Use of PDE5i was not significantly associated with lower postoperative RVF (OR 0.38, 95%CI 0.02-5.96, p=0.41). There was no significant association between PDE5i and gastrointestinal (GI) bleeding (OR 1.23, 95%CI 0.76-1.98, p=0.2), overall stroke (OR 0.60, 95%CI 0.21-1.68, p=0.17), ischemic stroke (OR 0.61, 95%CI 0.09-4.07, p=0.38), and pump thrombosis (OR 0.71, 95%CI 0.14-3.54, p=0.46). CONCLUSIONS Our meta-analysis showed no significant association between PDE5i and post-LVAD RVF. Despite the anti-platelet effects of PDE5i, there was no significant association between PDE5i and GI bleeding, overall stroke, ischemic stroke, and pump thrombosis. Randomized-controlled studies are warranted to evaluate the net benefits or harms of PDE5i in LVAD population.