ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Use of oral sildenafil to facilitate weaning from inhaled nitric oxide following congenital heart surgery: our clinical experiences
Ahmet Şaşmazel1, Taylan Adademir1, Ayşe Baysal2, Naci Öner3, Mehmet Özkökeli1, Ekrem Yılmaz1, Hasan Sunar1, Rahmi Zeybek1
1Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
2Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul
3Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Pediatrik Kardiyoloji Kliniği, İstanbul
DOI : 10.5606/tgkdc.dergisi.2011.080
Background: This study aims to evaluate the results of the prophylactic use of oral sildenafil in weaning from inhaled nitric oxide (iNO) treatment following congenital cardiac surgery in severe pulmonary hypertensive patients.

Methods: Oral sildenafil (1 mg/kg, 4 times daily) was added to the treatment of 18 of 21 patients who had started iNO therapy intraoperatively, on the postoperative first day. The medical records of the patients were retrospectively evaluated with respect to the clinical status of rebound pulmonary artery hypertension, entubation time, duration of intensive care unit stay, and early and late mortality.

Results: Early mortality was seen in four (22.2%) of 18 patients with the sildenafil treatment protocol. Two (11.1%) deaths were due to low cardiac output on the postoperative first day, and the remaining two (11.1%) deaths were due to severe rebound pulmonary hypertensive crisis on the postoperative sixth and ninth days. In 14 (77.8%) of the patients, no rebound pulmonary hypertensive crisis was seen after the discontinuation of iNO with the oral sildenafil treatment.

Conclusion: The prophylactic use of sildenafil to facilitate iNO withdrawal can be beneficial in the prevention of rebound pulmonary hypertension following congenital cardiac surgery. Randomized controlled trials are needed to evaluate the safety and efficacy of the prophylactic use.

Keywords : Congenital heart surgery; nitric oxide; rebound pulmonary hypertension; sildenafil
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