The effect of intravenous iloprost on pulmonary artery hypertension after paediatric congenital heart surgery

• Published in: Interactive cardiovascular and thoracic surgery Vol. 22; no. 2; pp. 194 - 199
• Main Authors: Onan, Ismihan Selen, Ozturk, Erkut, Yildiz, Okan, Altin, Husnu Firat, Odemis, Ender, Erek, Ersin
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2016
• Subjects: Cardiac Surgical Procedures; Dose-Response Relationship, Drug; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - surgery; Humans; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Iloprost - administration & dosage; Infant; Infusions, Intravenous; Male; Postoperative Care - methods; Prospective Studies; Pulmonary Wedge Pressure - drug effects; Treatment Outcome; Vasodilator Agents - administration & dosage; Congenital heart surgery; Intravenous iloprost; Pulmonary arterial hypertension
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivv325

OBJECTIVES To investigate the effects of intravenous iloprost on pulmonary artery hypertension (PAH) in infants undergoing congenital heart surgery. METHODS In this prospective, randomized study, the study group (n = 15) received a continuous infusion of iloprost (2.0 ng/kg/min) that was delivered immediately after weaning from cardiopulmonary bypass and continued for 72 h postoperatively. Patients in the control group (n = 12) were managed conventionally. The groups were compared in terms of postoperative data, including systolic and mean pulmonary artery (PA) pressures, PA/systemic pressure ratio, lactate level, PAH crisis, ventilation time, reintubation and lengths of intensive care unit (ICU) and hospital stay. Transthoracic echocardiography was used to assess PA pressures at 1 day, 7 days and 30 days after surgery. RESULTS No mortality occurred. PAH crisis occurred in 2 (16.6%) patients in the control group and 4 (26.7%) patients in the study group (P = 0.53). Postoperative PA pressures and PA/systemic pressure ratios were similar between the groups (P > 0.05). The durations of ICU (P = 0.40) and hospital (P = 0.98) stays were similar between the groups. Echocardiographic studies demonstrated a significant decrease in postoperative PA pressures in the control (P = 0.001) and study (P = 0.0001) groups. However, no significant change was observed between the groups (P > 0.05). The Tukey multiple comparison test showed a significant decrease in PA pressures at each follow-up in both groups (P < 0.05). CONCLUSIONS Intravenous iloprost demonstrated no additional benefit over the conventional management of infants with PAH after repair of intracardiac defects. Clinicians may prefer other alternative agents in infants with a high risk of PAH crisis.