treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized,prospective, double-bind study.

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Abstract

Objective Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI(2)) and nitric oxide (iNO) compared with those of intravenous vasodilators. Methods This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes.s.cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography. Results Hospital mortality was 3.4%. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI(2) groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI(2) groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group. Conclusions Our data suggest that both iNO and iPGI(2) are effective in the treatment of pulmonary hypertension. iPGI(2) has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate.
Lingua originaleEnglish
pagine (da-a)119-123
RivistaTHE JOURNAL OF CARDIOVASCULAR MEDICINE
Volume2006
Stato di pubblicazionePublished - 2006

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Cardiopulmonary Bypass
Pulmonary Hypertension
Thoracic Surgery
Epoprostenol
Vasodilator Agents
Vascular Resistance
Pulmonary Artery
Intensive Care Units
Nitric Oxide
Pharmaceutical Preparations
Pressure
Right Ventricular Function
Control Groups
Mitral Valve Stenosis
Transesophageal Echocardiography
Therapeutics
Hospital Mortality
Double-Blind Method
Intubation
Stroke Volume

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@article{64e399fdf8834862a0a7fbd6ad9cdc58,
title = "treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized,prospective, double-bind study.",
abstract = "Objective Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI(2)) and nitric oxide (iNO) compared with those of intravenous vasodilators. Methods This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes.s.cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography. Results Hospital mortality was 3.4{\%}. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI(2) groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI(2) groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group. Conclusions Our data suggest that both iNO and iPGI(2) are effective in the treatment of pulmonary hypertension. iPGI(2) has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate.",
author = "Khalil Fattouch and Giuseppe Bianco and Giovanni Ruvolo and Roberta Sampognaro",
year = "2006",
language = "English",
volume = "2006",
pages = "119--123",
journal = "THE JOURNAL OF CARDIOVASCULAR MEDICINE",
issn = "0199-6614",

}

TY - JOUR

T1 - treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized,prospective, double-bind study.

AU - Fattouch, Khalil

AU - Bianco, Giuseppe

AU - Ruvolo, Giovanni

AU - Sampognaro, Roberta

PY - 2006

Y1 - 2006

N2 - Objective Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI(2)) and nitric oxide (iNO) compared with those of intravenous vasodilators. Methods This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes.s.cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography. Results Hospital mortality was 3.4%. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI(2) groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI(2) groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group. Conclusions Our data suggest that both iNO and iPGI(2) are effective in the treatment of pulmonary hypertension. iPGI(2) has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate.

AB - Objective Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI(2)) and nitric oxide (iNO) compared with those of intravenous vasodilators. Methods This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes.s.cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography. Results Hospital mortality was 3.4%. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI(2) groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI(2) groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group. Conclusions Our data suggest that both iNO and iPGI(2) are effective in the treatment of pulmonary hypertension. iPGI(2) has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate.

UR - http://hdl.handle.net/10447/2817

M3 - Article

VL - 2006

SP - 119

EP - 123

JO - THE JOURNAL OF CARDIOVASCULAR MEDICINE

JF - THE JOURNAL OF CARDIOVASCULAR MEDICINE

SN - 0199-6614

ER -