Why the study?
Pulmonary hypertension substantially contributes to morbidity and mortality in CHD surgery, but evidence regarding the efficacy and safety of commonly used pulmonary vasodilators and inodilators remains limited.
Does the perioperative use of pulmonary vasodilators and inodilators improve outcomes in pediatric patients undergoing congenital heart disease surgery?
Does the perioperative use of pulmonary vasodilators and inodilators improve outcomes in pediatric patients undergoing congenital heart disease surgery?
Pulmonary vasodilators and inodilators do not significantly decrease perioperative mortality in pediatric CHD surgery, though agents like IV sildenafil and inhaled NO offer modest benefits in reducing mechanical ventilation duration and ICU stay.
No mortality benefit warrants caution against routine use in pediatric CHD surgery; extends evidence for shorter ventilation with sildenafil and inhaled NO.
BACKGROUND: Perioperative management of congenital heart disease (CHD) surgery presents a unique challenge due to significant pathophysiological alterations, with pulmonary hypertension contributing substantially to morbidity and mortality. Although pulmonary vasodilators and inodilators are commonly used, evidence of their efficacy and safety remains limited. OBJECTIVES: To evaluate the effectiveness and safety of vasodilators and inodilators in pediatric patients undergoing CHD surgery. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: PubMed, CENTRAL, and Embase. ELIGIBILITY CRITERIA: We included single- or double-blind, parallel-group, randomized controlled trials comparing the perioperative use of vasodilators and inodilators in pediatric CHD surgery. We selected only English-language studies. We excluded crossover, non randomized trials and trials comparing the same drugs in all study arms. RESULTS: We included 28 randomized controlled trials involving 3118 patients. Intravenous levosimendan ranked highest in decreasing postoperative mortality, although the effect was not statistically significant. Intravenous sildenafil and inhaled nitric oxide (NO) significantly reduced the duration of mechanical ventilation, and inhaled NO also significantly shortened the length of intensive care unit stay. Inhaled iloprost, NO, and enteral sildenafil reduced mean pulmonary artery pressure. No intervention significantly affected the incidence of acute kidney injury. CONCLUSIONS: Vasodilators and inodilators did not significantly decrease perioperative mortality in pediatric CHD. Some agents, such as intravenous sildenafil and inhaled NO, demonstrated modest benefits of questionable clinical significance regarding duration of mechanical ventilation, intensive care unit stay, and pulmonary pressure. The results are limited by small sample sizes, study heterogeneity, variability in standard care, and risk of bias, requiring cautious interpretation. REGISTRATION: CRD42024552531.
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Ollosu et al. (2025) studied this question.
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