title: First experience with sildenafil after Fontan operation: short-term outcomes.
abstract: BACKGROUND
  We conducted a retrospective study to determine the effect of oral sildenafil administrated as monotherapy after Fontan operation in single ventricle physiology.
  
  
  METHODS
  From January 2008 to March 2012, during two different periods, a total of 30 pediatric patients undergoing Fontan operation by extracardiac conduit were included in this study. Thirteen patients were in the sildenafil group and exclusively treated with sildenafil given at the dose of 0.35 mg/kg through a nasogastric tube and then orally every 4 h, at the start of cardiopulmonary bypass and for the first postoperative week; then we reduced and discontinued the therapy. The other 17 patients were in the control group. No other vasodilator was administered in both groups. We analyzed intraoperative and postoperative outcomes of sildenafil administration.
  
  
  RESULTS
  There were no differences in mortality or operative time. The total and relative drainage loss was lower in the sildenafil group (P = 0.0003 and 0.0045). The hemodynamic parameters showed a better condition in the sildenafil group, with a lower mean pulmonary artery pressure (mPAP) (P = 0.0001) and better mPAP to mean systemic blood pressure (mSBP) ratio (P = 0.0043), whereas there was no difference in peripheral oxygen saturation (P = 0.31). The sidenafil group patients showed other additional positive differences as well as lower inotropic score (P = 0.0005) and intubation time (P = 0.0004). No complications related to the use of sildenafil were noted in any of the children studied.
  
  
  CONCLUSIONS
  This initial experience provides evidence that sildenafil may be used in postoperative Fontan operation with positive effectiveness.
authors.affiliation: Department of Clinical Medicine and Cardiovascular Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Giordano
authors.forename: Gaetano
authors.initials: G
authors.lastname: Palma
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Poli
authors.forename: Sergio
authors.initials: S
authors.lastname: Palumbo
authors.forename: Veronica
authors.initials: V
authors.lastname: Russolillo
authors.forename: Sabato
authors.initials: S
authors.lastname: Cioffi
authors.forename: Marco
authors.initials: M
authors.lastname: Mucerino
authors.forename: Vito Antonio
authors.initials: VA
authors.lastname: Mannacio
authors.forename: Carlo
authors.initials: C
authors.lastname: Vosa
mesh_terms: D000284:Administration, Oral; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011652:Pulmonary Circulation / Q000187:drug effects; D012189:Retrospective Studies; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D000068677:Sildenafil Citrate