BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease due to the incomplete resolution of pulmonary emboli, leading to right heart failure, with a poor survival. Pulmonary endarterectomy (PEA) is the operation of choice for CTEPH. Reperfusion lung injury and residual pulmonary hypertension remain most serious complications. Phosphodiesterase-5 inhibitor sildenafil was recently developed for the treatment of pulmonary arterial hypertension (PAH). We investigated the safety of the combination nitric oxide, iloprost and sildenafil in the perioperative period.
METHODS: Pulmonary endarterectomy for severe pulmonary hypertension was performed in 14 patients between 2009 and 2014. Combination of inhaled nitric oxide (20-50 ppm), inhaled illoprost (20 mcg × 8/day) and sildenafil (50mg × 3/day) were applied in subsequent order after disconnection from cardiopulmonary bypass and during early postoperative period. Haemodinamic parameters were studied by using pulmonary artery catheter.
RESULTS: 13 patients survived and had significant decrease in systolic pulmonary artery pressure 94.2 ± 26.6 mmHg vs. 33.7 ± 15.6 mmHg (p <0.001) and pulmonary vascular resistance 697 ± 212 dyn x s x cm(-5) vs. 123 ± 54 dyn x s x cm(-5) (p <0.001) postoperatively compared to preoperative data. No significant changes in systemic vascular resistance and systemic arterial pressure were observed.
CONCLUSION: The combination of nitric oxide, illoprost and sildenafil was well tolerated and induced additive, pulmonary selective vasodilatation in pulmonary hypertension patients in the perioperative period.
