Effectiveness of Sildenafil in Pulmonary Hypertension Secondary to Valvular Heart Disease: A Systematic Review and Meta-Analysis

Sildenafil is commonly used as off-label medication in Pulmonary Hypertension (PH) secondary to Valvular Heart Disease (VHD). Previously, published systematic review reported the efficacy of sildenafil for PH with VHD specifically in preoperative condition. We conducted this systematic review and meta-analysis to summarize the potential benefits of sildenafil at different treatment phases, namely acute or chronic. Articles available up to June 2020 were identified using Web of Science, Ovid & Medline, EBSCOHOST, the Cochrane Library, PubMed and Google scholar. Quality assessment and data analysis were conducted using Review Manager (RevMan) version 5.4 and Black and Downs' Checklist. A total of nine studies (n = 614 patients) were eligible for analysis. Sildenafil improved systolic pulmonary arterial pressure (sPAP) (MD -5.89 mmHg +/- 17.07), mean Pulmonary Arterial Pressure (mPAP) (MD -4.62 mmHg +/- 12.24) and Pulmonary Vascular Resistance Index (PVRI) (MD -60.11 dynes.sec.cm(5)m(2) +/- 500.85) during acute and chronic phase in three studies. Data showed no changes in systemic hemodynamic during acute phase but improved in CO and Cl readings during chronic phase. Sildenafil reduced mechanical ventilation time and post-operative recovery room stay during acute and chronic phases. Patients required inotrope support were similar between placebo and sildenafil groups during acute phase (RR, 0.51%; 95% Cl, 0.21-1.27); P = 0.15: no heterogeneity). Sildenafil has little or no effect on pulmonary and systemic hemodynamic, perioperative monitoring, 6MWT and composite clinical score whether it is given as preoperative or postoperative during acute or chronic treatment phase.