Evaluation of the preoperative administration of sildenafil on operative and early postoperative outcome after mitral valve replacement in patients with pulmonary hypertension

Abstract

<jats:p>Background: Mitral valve diseases are commonly associated with pulmonary hypertension. The aim of this study was to evaluate the effect of preoperative administration of sildenafil on the outcome after mitral valve replacement in patients with pulmonary hypertension.&#x0D; Methods: This prospective randomized study was carried out on 67 patients who had a mitral valve replacement and associated high systolic pulmonary artery pressure more than 50 mmHg. Patients were randomized into three groups: group A (n= 20) received preoperative sildenafil for one week, group B (n=22) received sildenafil for one month, and group C (n= 25) did not receive sildenafil. All patients had transthoracic echocardiography preoperatively, one week and one month postoperatively.&#x0D; Results: There was no difference in preoperative and operative variables among groups. Dobutamine support was required in 15 patients (60%) in group C vs. 6 patients (30%) in group A and 5 patients (22.5%) in group B (p= 0.012). Duration of mechanical ventilation was significantly longer in group C (389.2 ± 48.79 minutes) compared to group A and B (295.5 ± 17.01 and 281.4 ± 39.44 minutes, respectively, p&lt;0.001). ICU stay was longer in group C (61.72 ± 13.69 hours) compared to groups A and B (53.55 ± 14.49 and 45.64 ± 13.43 hours, respectively, p=0001). The hospital stay was longer in group C (8.0 ± 1.80 days) compared to group A and B (6.05 ± 0.94 and 6.27 ± 1.24 days, respectively; p&lt; 0.001). The transthoracic echocardiographic study one month after the operation showed that pulmonary artery systolic pressure significantly lower in groups A and B (28.30 ± 3.3 and 28.2 ± 4.98 mmHg, respectively) compared to group C (43.12 ± 4.99 mmHg) (p &lt;0.001). There was no statistically significant difference between groups A and B regarding PASP after five days (p= 0.287) or one month (p= 0.939).&#x0D; Conclusion: We found that preoperative administration of oral sildenafil in patients with pulmonary hypertension undergoing mitral valve replacement may reduce pulmonary hypertension postoperatively. We could not find a difference in the administration of sildenafil for either one week or one month preoperatively. </jats:p>

Effectiveness of Sildenafil in Pulmonary Hypertension Secondary to Valvular Heart Disease: A Systematic Review and Meta-Analysis

“…Ram et al (2019) reported that patients who received sildenafil were associated with shorter median mechanical lung ventilation time (16 vs. 19 hours, P = 0.431), intensive care unit stay (74 vs. 91 hours, P= 0.410), and total hospitalization stay (7 vs. 11 days, P = 0.009) compared to placebo. Comparable findings were also demonstrated in the study by Ibrahim et al (2020).…”

“…Acute sildenafil treatment showed no significant short-term benefits in reducing ventilation time or intensive care unit length of stay as shown in five studies [24,26,[28][29][30]. Acute sildenafil administration showed potential effects on inotrope requirement; such observation may be explained by the mechanism of sildenafil action, through its effects on pulmonary cyclic guanosine monophosphate which enhance the vasodilatory effect.…”

“…Sildenafil may have little or no effects on pulmonary hemodynamic parameters, specifically sPAP, mPAP, and PVRI following both acute and chronic treatment. The meta-analysis of eight RCTs [14,23,24,[26][27][28][29][30] suggested no significant association between pulmonary hemodynamic parameters and sildenafil doses with either acute or chronic administration. Our findings also showed that sPAP remained unchanged (24,25) when oral sildenafil was given at 25 mg three times daily over 24 -48 hours before surgery (intraoperative and post-operative) before surgery (intraoperative and post-operative) and at 40 mg three times daily over 6 months in the study by Bermejo et al (2018) [14].…”

Role of per-operative milrinone on pulmonary hypertension having mitral valve replacement.

“…Mitral valve disease commonly results in pulmonary hypertension, which is associated with poor prognosis during mitral valve replacement. 14,15 Mitral valve disease cause increase in left atrial pressures because of increase in pulmonary vascular resistance which in turn causes alveolar stress and remodeling of pulmonary vasculature. 16 As there are selective drugs for pulmonary vasculature, treatment of pulmonary hypertension has not been fully established.…”

Outcome of preoperative oral sildenafil in patients with pulmonary hypertension after mitral valve replacement.

“…2,7 In preoperative management of pulmonary hypertension, oral sildenafil is found very effective as it is a selective inhibitor of isoform 5 phosphodiestrase enzyme which increases in cyclic guanosine monophosphate (cGMP) levels. 8,9 Sildenafil can also be used to manage secondary pulmonary hypertension in perioperative period in patients undergoing open heart surgeries. 10 There are fewer studies on the use of oral sildenafil ragarding preoperative management of pulmonary hypertension with mitral valve disease.…”