Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy.
OBJECTIVE
Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of a double-blinded randomized trial with the aerosolized prostacyclin analogue iloprost in patients with residual pulmonary hypertension after PEA.


METHODS
Twenty-two patients (age, 55+/-13 years; 8 females; propofol- and sufentanil-based anesthesia; pressure-controlled mechanical ventilation) were randomized to receive either a single dose of 25 microg aerosolized iloprost (iloprost group; n=11) or normal saline (placebo group; n=11) immediately after postoperative ICU admission. Primary endpoints were changes in gas exchange, pulmonary and systemic hemodynamics, and clinical outcome.


RESULTS
Iloprost significantly enhanced cardiac index (CI) and reduced mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance [PVR (dynscm(-5))] in contrast to placebo. Placebo: pre-inhalation 413+/-195 versus post-inhalation 404+/-196 at 30 min (p=0.051), 415+/-189 at 90 min (p=0.929). Iloprost: pre-inhalation 503+/-238 versus post-inhalation 328+/-215 at 30 min (p=0.001), 353+/-156 at 90 min (p=0.003). Blood oxygenation remained unchanged.


CONCLUSIONS
In addition to the effect of PEA, iloprost reduces residual postoperative pulmonary hypertension, decreases right ventricular afterload and may facilitate the early postoperative management after PEA.
Kramm
Thorsten
T
Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Medical School, Langenbeckstr. 1, D-55131 Mainz, Germany. kramm@mail.uni-mainz.de
Eberle
Balthasar
B
Guth
Stefan
S
Mayer
Eckhard
E
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D004311:Double-Blind Method; D004691:Endarterectomy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
D014665:Vasodilator Agents; D002245:Carbon Dioxide; D016285:Iloprost; D010100:Oxygen