Key result
Pre- and post-operative sildenafil lowers post-CPB systolic pulmonary artery pressure by ~15 mmHg versus placebo.
Why the study?
Does pre-operative initiation of sildenafil reduce perioperative pulmonary artery pressure in children with ventricular septal defects and pulmonary hypertension undergoing corrective surgery?
RCT (n=60)
randomly
Does pre-operative initiation of sildenafil reduce perioperative pulmonary artery pressure in children with ventricular septal defects and pulmonary hypertension undergoing corrective surgery?
Answers are grounded in this paper and cite their sources.
Initiating sildenafil pre-operatively rather than post-operatively significantly improves perioperative pulmonary artery pressures and reduces ICU stay in children undergoing VSD repair.
Background and Aims: Sildenafil is known to reduce pulmonary artery pressure but its role in the perioperative period has not been well studied. We aimed to evaluate the efficacy of sildenafil in controlling post-operative pulmonary hypertension in children with pulmonary hypertension undergoing surgeries for correction of ventricular septal defect. Methods: The patients were divided randomly into two groups of thirty each. Group 1 (placebo) received pre-operative placebo and post-operative sildenafil (0.5mg/kg every 6 hrs) while Group 2 (sildenafil) received pre- and post-operative sildenafil (0.5mg/kg every 6 hrs) Results: In the Group 1, systolic pulmonary artery pressure reduced from 81.63 (±12.1) mmHg preoperatively to 79.26 (±11.29) mmHg pre-cardiopulmonary bypass (CPB) and 56.76 (±11) mmHg (with 10 minutes post-CPB), whereas in Group 2, it reduced from 83.3 (±12.1) before surgery to 68.9 (±11.3) mmHg pre-CPB and after CPB, to 42.2 (±7.6) mmHg (P = 0.001). The mean pulmonary artery pressure decreased from 60.63 (±10.5) mmHg to 42.13 (±8.3) mmHg in the Group 1 whereas it reduced from 54.36 (±10) mmHg to 31.36 (±6.5) mmHg in Group 2 (P = 0.001). The reductions in pulmonary artery/aortic ratio and Intensive Care Unit stay were statistically significant No adverse effects were recorded. Conclusion: The use of perioperative sildenafil has a statistically significant reduction in the mean pulmonary artery pressure without any adverse effects.
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BHASIN et al. (2017) conducted an RCT in Ventricular septal defects and associated pulmonary hypertension (n=60). Pre- and post-operative sildenafil vs. Pre-operative placebo and post-operative sildenafil was evaluated on Systolic pulmonary artery pressure post-cardiopulmonary bypass (p=0.001). Pre- and post-operative sildenafil reduced post-cardiopulmonary bypass systolic pulmonary artery pressure compared to pre-operative placebo.
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