Key result
Intravenous prostaglandin E1 therapy significantly reduced mean pulmonary arterial pressure at 12 months (32.2 vs 40.2 mm Hg; P=0.008) and eliminated deaths from pulmonary hypertension crisis (0% vs 26.7%; P=0.029).
Why the study?
Does intravenous prostaglandin E1 reduce pulmonary arterial pressure and improve survival in patients with residual pulmonary arterial hypertension following corrective surgery for congenital heart disease?
RCT (n=31)
randomly divided
Does intravenous prostaglandin E1 reduce pulmonary arterial pressure and improve survival in patients with residual pulmonary arterial hypertension following corrective surgery for congenital heart disease?
Absolute Event Rate: 32.2% vs 40.2%
p-value: p=.008
Intravenous PGE1 therapy significantly reduces mean pulmonary arterial pressure and improves survival in patients with residual PAH after congenital heart disease surgery.
Supports intravenous PGE1 for residual PAH after congenital heart repair; extends RCT evidence to this population with limited options.
OBJECTIVE: To evaluate the therapeutic effects of prostaglandin E(1) (PGE(1)) on residual pulmonary arterial hypertension (PAH) after corrective surgery for congenital heart disease. METHODS: Thirty-one patients with postoperational PAH were randomly divided into control group (n = 15) and PGE(1) group (n = 16, 6 courses of intravenous PGE(1) plus conventional therapy). Mean pulmonary arterial pressure (MPAP), right ventricular ejection fraction (RVEF), and left ventricular ejection fraction (LVEF) were measured by echocardiography before and 3, 6, and 12 months after the treatment. Arterial oxygen pressure (Pao (2)) was monitored. RESULTS: In both groups, MPAP decreased and RVEF, LVEF, and Pao (2) increased at 6 and 12 months following surgery. In the PGE(1) group, the MPAP (32.2 ± 5.2 vs 40.2 ± 5.1 mm Hg; P = .008) was lower and RVEF (66.6% ± 6.5% vs 54.9% ± 2.1%; P = .019), LVEF (65.9% ± 3.9% vs 53.5% ± 5.1%; P = .031), and Pao (2) (94.3% ± 11.2% vs 93.1% ± 11.3%; P = .009) was higher than in the control group 12 months after the surgery. Four patients (26.7%) in the control group died of pulmonary hypertension crisis, but there was no death in the PGE(1) group (P = .029). Cumulative survival rate in the control group were 86.7%, 80%, 73.3%, and 73.3% at 1, 2, 3, and 5 years, respectively. CONCLUSIONS: Intravenous PGE(1) therapy after corrective surgery for congenital heart disease was associated with a reduction in mean pulmonary arterial pressure and a lower risk of death.
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Dong et al. (2011) conducted an RCT in residual pulmonary arterial hypertension (PAH) after corrective surgery for congenital heart disease (n=31). Prostaglandin E1 (PGE1) vs. conventional therapy was evaluated on Mean pulmonary arterial pressure (MPAP) at 12 months (p=.008). Intravenous prostaglandin E1 therapy significantly reduced mean pulmonary arterial pressure at 12 months (32.2 vs 40.2 mm Hg; P=0.008) and eliminated deaths from pulmonary hypertension crisis (0% vs 26.7%; P=0.029).
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