Hemodynamic Effects of Combination Therapy With Inhaled Nitric Oxide and Iloprost in Patients With Pulmonary Hypertension and Right Ventricular Dysfunction After High-Risk Cardiac Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 27; no. 3; pp. 459 - 466
• Main Authors: Antoniou, Theofani, MD, PhD, Koletsis, Efstratios N., MD, PhD, Prokakis, Christos, MD, PhD, Rellia, Panagiota, MD, Thanopoulos, Apostolos, MD, Theodoraki, Kassiani, MD, PhD, Zarkalis, Dimitrios, MD, Sfyrakis, Petros, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2013
• Subjects: Aerosols; Aged; Anesthesia & Perioperative Care; Arterial Pressure - physiology; Cardiac Surgical Procedures - methods; Critical Care; Electrocardiography; Extracorporeal Circulation; Female; Heart Valves - surgery; Hemodynamics - drug effects; Humans; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - physiopathology; iloprost; Iloprost - administration & dosage; Iloprost - therapeutic use; inhaled nitric oxide; Male; Middle Aged; Nitric Oxide - administration & dosage; Nitric Oxide - therapeutic use; pulmonary hypertension; right ventricular dysfunction; Risk; Treatment Outcome; tricuspid annular plane systolic excursion; tricuspid annular velocity; Vascular Resistance - physiology; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Ventricular Dysfunction, Right - drug therapy; Ventricular Dysfunction, Right - physiopathology; tricuspid annular velocity; tricuspid annular plane systolic excursion; right ventricular dysfunction; inhaled nitric oxide; iloprost; pulmonary hypertension
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2012.07.020

Objective The purpose of this study was to evaluate the hemodynamic effects of inhaled nitric oxide (NO) plus aerosolized iloprost in patients with pulmonary hypertension/right ventricular dysfunction after cardiac surgery. Design A retrospective study. Setting A single center. Participants Eight consecutive patients with valve disease and postextracorporeal circulation (ECC) pulmonary hypertension/right ventricular dysfunction. Intervention The continuous inhalation of nitric oxide (10 ppm) and iloprost, 10 μg, in repeated doses. Measurements and Main Results The hemodynamic profile was obtained before inhalation, during the administration of inhaled NO alone (prior and after iloprost), and after the first 2 doses of iloprost. Tricuspid annular velocity and tricuspid annular plane systolic excursion were estimated at baseline and before and after adding iloprost. At the end of the protocol, there were significant decreases in pulmonary vascular resistance ( p < 0.001), the mean pulmonary arterial pressure ( p < 0.001), and the mean pulmonary artery pressure/mean arterial pressure ratio ( p = 0.006). Both tricuspid annular velocity ( p < 0.001) and tricuspid annular plane systolic excursion ( p < 0.001) increased. The cardiac index ( p < 0.001) and venous blood oxygen saturation ( p = 0.001) increased throughout the evaluation period. Each iloprost dose was associated with further decreases in pulmonary vascular resistances/pressure. By comparing data at the beginning of inhaled NO with those after the second dose of iloprost, the authors noticed decreases in pulmonary vascular resistances ( p = 0.004) and the mean pulmonary artery pressure ( p = 0.017) and rises in tricuspid annular velocity ( p < 0.001) and tricuspid annular systolic plane systolic excursion ( p < 0.001). Conclusions Inhaled NO and iloprost significantly reduced pulmonary hypertension and contributed to the improvement in right ventricular function. Inhaled NO and iloprost have additive effects on pulmonary vasculature.