title: A prospective, randomized study of inhaled prostacyclin versus nitric oxide in patients with residual pulmonary hypertension after pulmonary endarterectomy.
abstract: OBJECTIVE
  Pulmonary endarterectomy (PEA) is an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative residual hypertension leads to in-hospital mortality. Inhaled epoprostenol sodium (PGI2) and NO are administered for pulmonary hypertension after cardiothoracic surgery. This prospective study provides the first comparative evaluation of the effects of inhaled PGI2and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange in patients developing residual pulmonary hypertension after PEA.
  
  
  METHODS
  Thirteen patients were randomized to receive either NO (n = 6) or PGI2 (n = 7) inhalation when pulmonary hypertension persisted after weaning from cardiopulmonary bypass. Hemodynamic and respiratory variables were measured before inhalation of the agent (T0); 30 min (T1), 3 h (T2), and 6 h after inhalation (T3); and the next morning (T4). The NO dose was started at 20 ppm and gradually tapered until extubation, and PGI2was administered at a dose of 10 ng kg-1min-1.
  
  
  RESULTS
  In both groups, mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) significantly decreased over time until T4 (mean PAP: p < 0.0001; PVR: p = 0.003), while mean systemic arterial blood pressure significantly increased (p = 0.028). There were no significant between-group differences in patient characteristics, cardiac index, left atrial pressure, or ratio of arterial oxygen tension to fraction of inspired oxygen. There were no in-hospital deaths.
  
  
  CONCLUSIONS
  Both inhaled PGI2and NO significantly reduced PAP and PVR without adverse effects on systemic hemodynamics in patients who developed residual pulmonary hypertension after PEA. Inhaled PGI2can be offered as alternative treatment option for residual pulmonary hypertension.
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Shinichiro
authors: S
authors: Abe
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan. keiichi-ishida@pro.odn.ne.jp.
authors: Keiichi
authors: K
authors: Ishida
authors: Department of Cardiovascular Surgery, Chiba Medical Center, 4-1-2 Tsubakimori, Chuo-ku, Chiba, 260-0042, Japan.
authors: Masahisa
authors: M
authors: Masuda
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Hideki
authors: H
authors: Ueda
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Hiroki
authors: H
authors: Kohno
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Kaoru
authors: K
authors: Matsuura
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Yusaku
authors: Y
authors: Tamura
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Michiko
authors: M
authors: Watanabe
authors: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan.
authors: Goro
authors: G
authors: Matsumiya
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D004691:Endarterectomy / Q000009:adverse effects*; D045462:Endothelium-Dependent Relaxing Factors / Q000008:administration & dosage; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide; D011464:Epoprostenol
keywords: Chronic thromboembolic pulmonary hypertension; Inhaled nitric oxide; Inhaled prostacyclin; Pulmonary endarterectomy; Residual pulmonary hypertension