Perioperative Sildenafil Therapy in Pediatric Congenital Cardiac Disease Patients

Abstract

Sildenafil is a pulmonary artery hypertension (PH)-targeted drug that finds an increased indiscriminate use in children with PH secondary to congenital heart disease (CHD).We performed a meta-analysis to evaluate the effects of sildenafil on pediatric patients with PH secondary to CHD during perioperative period.PubMed, EMBASE, the Cochrane Library, and the Google Scholar were searched up to May 2016 for randomized controlled trials (RCTs) assessing the perioperative treatment of sildenafil in pediatric patients with PH secondary to CHD. Major clinical outcomes were mortality before discharge, length of ICU stay, and length of hospitalization. The outcomes were analyzed as continuous and dichotomized variables by using fixed or random effect model, and we computed the pooled RR and MD with 95% confidence interval.Five RCTs involving 238 pediatric patients with PH experienced CHD operation were included. Sildenafil was used in all trials. We observed no differences in mortality before discharge (RR 0.35; 95% CI 0.06-2.10; χ 2 = 1.31, I 2 = 0.24, P = 0.25) and length of hospitalization (MD −0.50; 95% CI −1.60 to 0.60; χ 2 = 5.29, I 2 = 62%, P = 0.38). There was a decrease in the length of ICU stay (MD −18.18; 95% CI −24.68 to −11.67; χ 2 = 12.61, I 2 = 84%, P < 0.00001), which had a high heterogeneity. The findings were robust after the sensitivity analyses.The perioperative treatment of sildenafil for CHD pediatric patients is a potential method to reduce the length of ICU stay. We observed no differences with the use of it in the mortality before discharge and the length of hospitalization.

Effect of Prophylactic Levosimendan on All-Cause Mortality in Pediatric Patients Undergoing Cardiac Surgery—An Updated Systematic Review and Meta-Analysis

“…Regarding the secondary outcomes, high heterogenicity was found in time of mechanical ventilation ( I 2 = 78.2%) and ICU stay ( I 2 = 84.8%), and we deemed that high heterogenicity may result from diversified factors, like different study design, drug administration method, time units, and perioperative management ideas. The random-effect model was used to analyze the two results, because it can decrease the effect of significant heterogeneity on the results, although this method does not solve heterogeneity ( 44 , 45 ). As a result, we obtained a significant difference in LCOS incidence but did not find any statistical difference in AKI incidence, and time of mechanical ventilation and ICU stay between groups of levosimendan and control.…”

Changes in ET-1, Plasma Neuropeptide Y, and CGRP in Child Patients With Congenital Heart Disease Complicated With Pulmonary Hypertension Before and After Operation

“…With the development of congenital heart disease (CHD), pulmonary hypertension (PH) may occur in patients, which is manifested as the elevation of systemic circulation pressure in clinic and pulmonary shunt. 1 This pathological event gives rise to the perfusion of blood into the alveoli of the lungs, but ventilation fails to supply the perfused region. Once pulmonary infection occurs simultaneously at this time, the pulmonary circulation pressure is caused to increase, leading to heart failure and even clinical death.…”

“…7 Relative clinical indexes, such as mean pulmonary arterial pressure (mPAP), right ventricular ejection fraction, left ventricular ejection fraction, and arterial oxygen pressure, are generally monitored for postoperation evaluation, which require complicated detection such as echocardiography. 8,9 However, there is still a lack of convenient and reliable hemodynamic factors for the 948261C PJXXX10.1177/0009922820948261Clinical PediatricsLiu et al research-article2020 1 The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China evaluation of surgical therapy, especially in resourcelimited settings.…”

Sildenafil for pulmonary hypertension in neonates: An updated systematic review and meta‐analysis

“…26 As a result, the Food and Drug Administration (FDA) in the United States issued a safety advisory against the use of sildenafil in pediatric patients (aged 1 to 17 years old) in 2012. 2,27 However, the FDA in the United States did not mention the risks of sildenafil use in neonates, especially in premature neonates. Some meta-analyses advocated the efficacy of sildenafil use in neonates, suggesting that sildenafil may substitute iNO in rescuing term and preterm neonates with PPHN, especially in resource-limited areas.…”