Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement.

Abstract

AIM:

Long standing mitral valve disease is usually associated with severe pulmonary hypertension. Perioperative pulmonary hypertension is a risk factor for right ventricular (RV) failure and a cause for morbidity and mortality in patients undergoing mitral valve replacement. Phosphodiesterase 5 inhibitor-sildenafil citrate is widely used to treat primary pulmonary hypertension. There is a lack of evidence of effects of oral sildenafil on secondary pulmonary hypertension due to mitral valve disease. The study aims to assess the effectiveness of preoperative oral sildenafil on severe pulmonary hypertension and incidence of RV failure in patients undergoing mitral valve replacement surgery.

MATERIALS AND METHODS:

A total of 40 patients scheduled for mitral valve replacement with severe pulmonary hypertension (RV systolic pressure (RVSP) ≥60 mmHg) on preoperative transthoracic echo were randomly treated with oral sildenafil 25 mg (N = 20) or placebo (N = 20) eight hourly for 24 h before surgery. Hemodynamic variables were measured 20 min after insertion of pulmonary artery catheter (PAC) under anesthesia (T1), 20 min at weaning from cardiopulmonary bypass (CPB) (T2) and after 1,2, and 6 h (T3, T4, T5, respectively) during the postoperative period.

RESULTS:

Systolic and mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) were significantly lower (P < 0.0001) in sildenafil group at all times. Ventilation time and postoperative recovery room stay were significantly lower (P < 0.001) in sildenafil group.

CONCLUSION:

Sildenafil produces significant pulmonary vasodilatory effect as compared with placebo in mitral valve replacement patients with severe pulmonary hypertension. It also reduces ventilation time and intensive care unit (ICU) stay time as compared with placebo. It is concluded that sildenafil is effective in reducing pulmonary hypertension when administered preoperatively in patients with severe pulmonary hypertension undergoing mitral valve replacement surgery.

• Authors: Hemang Gandhi, Bipin Shah, Ramesh Patel, Rajesh Toshani, Jigisha Pujara, Jignesh Kothari, Naman Shastri
• Journal: Indian journal of pharmacology (Indian J Pharmacol) 2014 May-Jun Vol. 46 Issue 3 Pg. 281-5 ISSN: 1998-3751 [Electronic] India
• PMID: 24987174 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Phosphodiesterase 5 Inhibitors
• Piperazines
• Purines
• Sulfones
• Sildenafil Citrate

Topics

• Administration, Oral
• Adult
• Arterial Pressure (drug effects)
• Double-Blind Method
• Female
• Heart Valve Prosthesis Implantation
• Humans
• Hypertension, Pulmonary (drug therapy, physiopathology)
• Male
• Middle Aged
• Mitral Valve (transplantation)
• Phosphodiesterase 5 Inhibitors (therapeutic use)
• Piperazines (therapeutic use)
• Preoperative Period
• Purines (therapeutic use)
• Sildenafil Citrate
• Sulfones (therapeutic use)