A comparison of prostacyclin and sodium nitroprusside for the treatment of heart failure after cardiac surgery.
OBJECTIVE
To study the effects of the two vasodilators, prostacyclin and sodium nitroprusside, on central hemodynamics in heart failure after cardiac surgery.


METHODS
Randomized cross-over study.


METHODS
Multi-institutional university hospital.


METHODS
Ten patients.


METHODS
cardiac index less than 2.5 L/min/m2; pulmonary capillary wedge pressure greater than 15 mmHg, systemic vascular resistance index greater than 2,500 dynes.s.cm-5/m2, and treatment with inotropic support. Five patients were treated with intra-aortic balloon counterpulsation.


METHODS
After control measurements, mean arterial pressure was decreased by 10% to 20% with each vasodilator in each patient.


RESULTS
Sodium nitroprusside induced decreases in mean pulmonary arterial pressure (-21%), pulmonary capillary wedge pressure (-29%), central venous pressure (-17%), and systemic vascular resistance (-25%), and increases in cardiac output (+7%) and stroke volume (+6%) compared with control. Prostacyclin decreased mean pulmonary arterial pressure (-14%), pulmonary capillary wedge pressure (-19%), central venous pressure (-7%), and systemic (-40%) and pulmonary (-25%) vascular resistances, whereas cardiac output (+25%) and stroke volume (+22%) increased compared with control. Prostacyclin, compared with sodium nitroprusside, induced a more pronounced increase in cardiac output and stroke volume, associated with less pronounced decreases in cardiac filling pressures and more profound decreases in systemic and pulmonary vascular resistances.


CONCLUSIONS
Prostacyclin appears to be a useful agent, superior to sodium nitroprusside, in the treatment of postoperative heart failure in patients with normal or mildly elevated cardiac filling pressures, where vasodilator treatment is indicated.
Kieler-Jensen
N
N
Department of Anesthesia and Intensive Care, University of Gothenburg, Sweden.
Houltz
E
E
Ricksten
S E
SE
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002496:Central Venous Pressure / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D018592:Cross-Over Studies; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage / Q000627:therapeutic use*; D011651:Pulmonary Artery / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D011464:Epoprostenol