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Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement
Hemang Gandhi1, Bipin Shah1, Ramesh Patel1, Rajesh Toshani1, Jigisha Pujara1, Jignesh Kothari2, Naman Shastri1
1 Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India
2 Department of Cardio Vascular Thoracic Surgery, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat, India
Correspondence Address:
Naman Shastri
Department of Cardiac Anesthesia, Uttambhai Nathalal Mehta Institute of Cardiology and Research Center, Sir Byramjee Jeejeebhoy Medical College, Civil Hospital, Asarwa, Ahmadabad, Gujarat
India
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.
How to cite this article:
Gandhi H, Shah B, Patel R, Toshani R, Pujara J, Kothari J, Shastri N. Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement.Indian J Pharmacol 2014;46:281-285
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How to cite this URL:
Gandhi H, Shah B, Patel R, Toshani R, Pujara J, Kothari J, Shastri N. Effect of preoperative oral sildenafil on severe pulmonary artery hypertension in patients undergoing mitral valve replacement. Indian J Pharmacol [serial online] 2014 [cited 2023 Mar 27 ];46:281-285
Available from: https://www.ijp-online.com/article.asp?issn=0253-7613;year=2014;volume=46;issue=3;spage=281;epage=285;aulast=Gandhi;type=0 |
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