alexa A Prospective Randomised Study of Postoperative Prophylactic Application of Sildenafil After Pediatric Cardiac Surgery
ISSN: 2155-9880

Journal of Clinical & Experimental Cardiology
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Research Article

A Prospective Randomised Study of Postoperative Prophylactic Application of Sildenafil After Pediatric Cardiac Surgery

Anna Hofer1*, Martina Heschl1, Clemens Kern1, Eva Grohmann2, Eva Sames-Dolzer3, Hans Gombotz3 and Jens Meier1
1Department of Anaesthesiology and Intensive Care, Kepler Universitätsklinikum, Linz, Austria
2Department of Pediatric Cardiology, Kepler Universitätsklinikum, Linz, Austria
3Department of Congenital Cardiac Surgery, Kepler Universitätsklinikum, Linz, Austria
Corresponding Author : Anna Hofer
Department of Anaesthesiology and Intensive Care
Kepler Universitätsklinikum, Linz, Austria
Tel: +43-732-7806-2158
E-mail: [email protected]
Received: July 13, 2015 Accepted: August 10 2015 Published: August 17 2015
Citation: Hofer A, Heschl M, Kern C, Grohmann E, Sames-Dolzer E, et al. (2015) A Prospective Randomised Study of Postoperative Prophylactic Application of Sildenafil After Pediatric Cardiac Surgery. J Clin Exp Cardiolog 6:392. doi:10.4172/2155-9880.1000392
Copyright: © 2015 Hofer A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Postoperative aggravation of pulmonary hypertension after pediatric cardiac surgery due to temporary endothelial dysfunction may lead to sudden pulmonary arterial pressure rise with compromise of right ventricular function. Though treatment with inhaled nitric oxid (NO) has been successful, rebound pulmonary hypertension has been observed after NO withdrawal due to supression of endogenous NO sythase. Sildenafil has been shown to prevent this reaction and is widely used after pediatric cardiac surgery. The aim of our study was to evaluate the effectively of postoperative administration of oral sildenafil (1 mg/kg/day) in preventing postoperative pulmonary hypertensive crises. 21 patients after repair of complete atrioventricular canal (n=10) or ventricular septal defect (n=11) were randomly assigned to the study group or control group. The study group received sildenafil after surgery via nasogastric tube every eight hours for 48 hours, the control group received placebo. The primary outcome parameter was the number of pulmonary hypertensive events (spontaneous pulmonary arterial pressure rise to or above systemic arterial pressure). Secondary outcome parameters were: need for inotropic drugs, fluid balance, urinary output, days on the ventilator or in the intensive care unit (ICU). There was no difference in the number of pulmonary hypertensive events between both groups: median (IQR); 2 (0-6,5) sildenafil, 1 (0-2) placebo, p=0,67. Neither inotrope score, time on the ventilator, ICU length of stay, nor fluid balance differed significantly. Urinary output was significantly lower in the sildenafil group.

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