Immediate postoperative administration of the phosphodiesterase-5 inhibitor sildenafil after mitral valve surgery is safe and effectively decreases pulmonary vascular pressure without systemic hypotension and ventilation-perfusion divergence in patients with secondary pulmonary hypertension, according to study results published in the Journal of Cardiothoracic and Vascular Anesthesia.

Investigators conducted a double-blind, placebo-controlled, randomized trial in the cardiac surgery department intensive care unit at Sheba Medical Center in Israel. Fifty patients who experienced pulmonary hypertension (systolic pressure >50 mm Hg) and recently underwent mitral valve surgery (either replacement or repair) participated in the study.

Twenty-five received sildenafil; the other half received a placebo. The sildenafil group received 20 mg sildenafil every 8 hours. The placebo group received a placebo on the same schedule. A pulmonary artery catheter was used to study hemodynamic parameters at baseline and every 6 to 36 hours throughout the duration of the study.


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Mean pulmonary pressure decreased significantly in the sildenafil group from 32±7 mm Hg at baseline to 26±3 mm Hg after 36 hours. No corresponding change was noted in the placebo group, which had a mean pulmonary pressure of 34±6 mm Hg at baseline and 35±5 mm Hg after 36 hours (P <.001).

Investigators did not observe any changes in systemic hemodynamic or oxygenation. Patients in the sildenafil group had lower median mechanical lung ventilation time (16 hours vs 19 hours, P =.431), intensive care unit stay (74 hours vs 91 hours, P =.410), and total hospitalization stay (7 days vs 11 days, P =.009).

Administering sildenafil immediately after mitral valve surgery in patients with pulmonary hypertension is safe and decreases pulmonary vascular pressure without inducing systemic hypotension and ventilation-perfusion mismatch.

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Investigators suggested that sildenafil be considered in all patients with pulmonary hypertension secondary to mitral valve surgery regardless of their respiratory or hemodynamic state.

Reference

Ram E, Sternik L, Klempfner R, et al. Sildenafil for pulmonary hypertension in the early postoperative period after mitral valve surgery [published online December 25, 2018]. J Cardothorac Vasc Anesth. doi: 10.1053/j.jvca.2018.12.023