Inhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery.
OBJECTIVE
Pulmonary hypertension is commonly found in patients undergoing valvular surgery and can be worsened by cardiopulmonary bypass. Inhaled epoprostenol (prostacyclin) has been used for the treatment of pulmonary hypertension, but its effects compared with those of placebo on hemodynamics, oxygenation, echocardiographic examination, and platelet function have not been studied during cardiac surgery.


METHODS
Twenty patients with pulmonary hypertension undergoing cardiac surgery were randomized in a double-blind study to receive inhaled epoprostenol (60 microg) or placebo. The inhalation occurred after induction of anesthesia and before surgical incision. The effects on left and right systolic and diastolic cardiac functions evaluated by means of pulmonary artery catheterization and transesophageal echocardiography, as well as oxygenation and platelet aggregation, were studied.


RESULTS
Inhalation of epoprostenol significantly reduced indexed right ventricular stroke work from 10.7 +/- 4.57 g. m. m(-2) to 7.8 +/- 3.94 g. m. m(-2) (P =.003) and systolic pulmonary artery pressure from 48.4 +/- 18 mm Hg to 38.9 +/- 11.9 mm Hg (P =.002). The effect was correlated with the severity of pulmonary hypertension (r = 0.76, P =.01) and was no longer apparent after 25 minutes. There was no significant effect on systemic arterial pressures, left ventricular function, arterial oxygenation, platelet aggregation, and surgical blood loss.


CONCLUSIONS
Inhaled epoprostenol reduces pulmonary pressure and improves right ventricular stroke work in patients with pulmonary hypertension undergoing cardiac surgery. A dose of 60 microg is hemodynamically safe, and its effect is completely reversed after 25 minutes. We did not observe any evidence of platelet dysfunction or an increase in surgical bleeding after administration of inhaled epoprostenol.
Haché
Manon
M
Montreal Heart Institute, Quebec, Canada.
Denault
André
A
Bélisle
Sylvain
S
Robitaille
Danielle
D
Couture
Pierre
P
Sheridan
Peter
P
Pellerin
Michel
M
Babin
Denis
D
Noël
Nicolas
N
Guertin
Marie-Claude
MC
Martineau
Raymond
R
Dupuis
Jocelyn
J
D000280:Administration, Inhalation; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002407:Catheterization, Swan-Ganz; D003971:Diastole / Q000187:drug effects; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects; D011292:Premedication / Q000379:methods*; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects
D000959:Antihypertensive Agents; D011464:Epoprostenol