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Sildenafil for Pulmonary Hypertension in the Early Postoperative Period After Mitral Valve Surgery

Published:January 24, 2019DOI:https://doi.org/10.1053/j.jvca.2018.12.023

      Objectives

      The phosphodiesterase-5 inhibitor sildenafil was developed for the treatment of pulmonary hypertension. The authors investigated the efficacy and safety of sildenafil in the early postoperative period after mitral valve surgery in patients with pulmonary hypertension.

      Design

      A double-blind, placebo-controlled randomized trial was performed.

      Setting

      The trial was performed in a single tertiary referral center.

      Participants

      Fifty consecutive patients who experienced pulmonary hypertension and underwent mitral valve surgery.

      Interventions

      Patients were randomly assigned to the following 2 groups: 25 patients received 20 mg sildenafil every 8 hours, and the remaining 25 patients received placebo during the same period. Hemodynamic parameters were studied by using a pulmonary artery catheter at baseline and every 6 hours up to 36 hours.

      Results

      Patients who received sildenafil showed a decrease in mean pulmonary pressure, from 32 ± 7 mmHg at baseline to 26 ± 3 mmHg after 36 hours, whereas no change was seen in patients who received placebo (mean pulmonary pressure 34 ± 6 mmHg at baseline and 35 ± 5 mmHg after 36 h) (p < 0.001). No significant changes in systemic hemodynamic and oxygenation were observed. Patients who received sildenafil compared with those who received placebo had a median mechanical lung ventilation time of 16 (10-31) hours versus 19 (13-41) hours (p = 0.431), intensive care unit stay of 74 (44-106) hours versus 91 (66-141) hours (p = 0.410), and a total hospitalization stay of 7 (5-10) days versus 11 (7-15) days (p = 0.009).

      Conclusions

      The immediate postoperative administration of sildenafil after mitral valve surgery is safe. Sildenafil demonstrates a favorable decreasing effect on pulmonary vascular pressure without systemic hypotension and ventilation–perfusion mismatch.

      Key Words

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      Linked Article

      • Sildenafil: Time to Look Beyond Pulmonary Pressures
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 33Issue 6
        • Preview
          IN THIS ISSUE of the journal, Ram et al.1 report on their study on the effects of postoperative sildenafil in patients with pulmonary hypertension undergoing mitral valve surgery. This expands on previous work done in postoperative patients with pulmonary hypertension, including the study by Jiang et al.,2 in which a single, larger dose of sildenafil was used postoperatively in 90 adult patients, and a study by Raja et al.,3 who examined a dose range of 0.5 to 2 mg/kg in 10 pediatric patients who also were on nitric oxide.
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