Prostacyclins in Cardiac Surgery: Coming of Age

Deshpande, Seema; Mazzeffi, Michael; Strauss, Erik; Hollis, Allison; Tanaka, Kenichi A.

doi:10.1177/1089253217749298

Cited by 7 publications

(4 citation statements)

References 61 publications

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“…Treprostinil, a synthetic prostacyclin mimetic, was developed to address the short in vivo half-life of both epoprostenol (∼3 min) and iloprost (∼20-30 min). 19 Several formulations of treprostinil now exist, and the drug can be administered SC, orally, IV, and by inhalation. Prostacyclin class agents are typically used as add-on therapy or reserved for patients with severe disease and are assumed to have a mechanism of action similar to that of endogenous PGI 2 , although this is a topic of active research.…”

Section: Methodsmentioning

confidence: 99%

Combination Therapy in Pulmonary Arterial Hypertension—Targeting the Nitric Oxide and Prostacyclin Pathways

Mandras¹,

Kovàcs

Olschewski

et al. 2021

J Cardiovasc Pharmacol Ther

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Pulmonary arterial hypertension (PAH) is a chronic and progressive disorder characterized by vascular remodeling of the small pulmonary arteries, resulting in elevated pulmonary vascular resistance and ultimately, right ventricular failure. Expanded understanding of PAH pathophysiology as it pertains to the nitric oxide (NO), prostacyclin (prostaglandin I2) (PGI2) and endothelin-1 pathways has led to recent advancements in targeted drug development and substantial improvements in morbidity and mortality. There are currently several classes of drugs available to target these pathways including phosphodiesterase-5 inhibitors (PDE5i), soluble guanylate cyclase (sGC) stimulators, prostacyclin class agents and endothelin receptor antagonists (ERAs). Combination therapy in PAH, either upfront or sequentially, has become a widely adopted treatment strategy, allowing for simultaneous targeting of more than one of these signaling pathways implicated in disease progression. Much of the current treatment landscape has focused on initial combination therapy with ambrisentan and tadalafil, an ERA and PDE5I respectively, following results of the AMBITION study demonstrating combination to be superior to either agent alone as upfront therapy. Consequently, clinicians often consider combination therapy with other drugs and drug classes, as deemed clinically appropriate, for patients with PAH. An alternative regimen that targets the NO and PGI2 pathways has been adopted by some clinicians as an effective and sometimes preferred therapeutic combination for PAH. Although there is a paucity of prospective data, preclinical data and results from secondary data analysis of clinical studies targeting these pathways may provide novel insights into this alternative combination as a reasonable, and sometimes preferred, alternative approach to combination therapy in PAH. This review of preclinical and clinical data will discuss the current understanding of combination therapy that simultaneously targets the NO and PGI2 signaling pathways, highlighting the clinical advantages and theoretical biochemical interplay of these agents.

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Section: Methodsmentioning

confidence: 99%

Combination Therapy in Pulmonary Arterial Hypertension—Targeting the Nitric Oxide and Prostacyclin Pathways

Mandras¹,

Kovàcs

Olschewski

et al. 2021

J Cardiovasc Pharmacol Ther

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“…The literature on the use of epoprostenol in the setting of our topic is extremely sparse and the latest report dates from 2006. In 2018, Deshpande et al reviewed the pharmacology and the use of prostacyclin analogues in the management of HIT during cardiac surgery [52].…”

Section: Prostacyclin Receptor Agonists Epoprostenolmentioning

confidence: 99%

“…It is a synthetic analogue of PGI2. Iloprost is a more stable compound and has a longer half-life of 15-30 min, compared to only six minutes for natural PGI2 [52]. It is primarily metabolized through hepatic β-oxidation, and its half-life is prolonged in patients with hepatic dysfunction and in patients with severe kidney disease requiring dialysis.…”

Section: Iloprostmentioning

confidence: 99%

How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass

Revelly

Scala

Rosner

et al. 2023

JCM

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Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of platelets in the presence of heparin in functional in vitro tests confirm the diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high risk of lethal complications and present specific challenges. Four distinct phases are described in the usual HIT timeline, and the anticoagulation strategy chosen for CPB depends on the phase in which the patient is categorized. In this sense, we developed an institutional protocol covering each phase. It consisted of the use of a non-heparin anticoagulant such as bivalirudin, or the association of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins (IvIg) has recently been described as a complementary strategy. In this article, we briefly described the pathophysiology of HIT and focused on the various strategies that can be applied to safely manage CPB in these patients.

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“…Much like Peacock's approach to seeking a greater understanding of congenital cardiac disease, Seema and colleagues have provided an excellent review that goes into great depth about the application of prostacyclin therapy in the management of cardiac surgery patients. 12 This has applications in both the adult and congenital world, and the authors provide perhaps the most comprehensive and current description of the mechanisms of action of prostacyclins along with current clinical applications. The article also includes a wide array of explanatory figures and tables that illustrate the key sites of action of these drugs, as well as how their clinical indication and applicability.…”

mentioning

confidence: 99%

Thomas Bevill Peacock and the First Descriptions of Congenital Heart Disease

Twite

Kertai

Weitzel

2018

Semin Cardiothorac Vasc Anesth

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School" who emphasized clinicopathological correlation and enthusiastically used Laennec's recent invention, the stethoscope. This instrument revolutionized the diagnosis of diseases of the chest and led to unprecedented interest in disorders of the heart.Peacock eventually practiced medicine at St Thomas's Hospital, London. He was highly regarded as a teacher and a popular lecturer. Many of Peacock's lectures and papers dealt with anomalies and diseases of the cardiovascular system. His book, On Malformations of the Human Heart is considered to be the first account to present congenital heart disease (CHD) in an organized fashion. Unlike many of his contemporaries who wrote about CHD cases in haphazard fashion because of a lack of pathophysiologic principles, Peacock combined anatomy and embryology to classify CHD into 4 categories: misplacements of the heart, pericardial abnormalities, cardiac malformations, and irregularities of primary vessels. 3 Peacock's book was well written, included 5 engravings depicting congenital cardiac malformations and was supplemented by useful bibliographies. In a careful analysis of more than 100 cases of CHD for which clinical information was available, Peacock found that three-quarters of the patients had symptoms at birth or shortly thereafter and half of the remainder became symptomatic during the first year of life.This issue of the journal brings together 8 articles relevant to the practice of congenital cardiac anesthesia. Six articles review the clinicopathological aspects of pulmonary atresia with an intact ventricular septum, truncus arteriosus, and interrupted aortic arch. The remaining 2 articles are original studies about the airway in children with CHD. The review articles are very consistent with Peacock's work describing the embryology, anatomy, and clinical relevance of congenital heart lesions. What Peacock could not imagine is the modern era of imaging these abnormalities with echocardiography, computed tomography (CT) scans, cardiac magnetic resonance imaging (cMRI), and the current therapeutic options in the cardiac catheterization laboratory and surgical approaches. Chikkabyrappa and colleagues describe the perioperative physiology, imaging and management of pulmonary atresia with an intact ventricular septum (PA-IVS) with an accompanying article by Gleich and colleagues describing the perioperative anesthetic considerations. 4,5 Together, these 2 articles 788914S CVXXX10.1177/1089253218788914Seminars in Cardiothoracic and Vascular AnesthesiaTwite et al editorial2018

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Prostacyclins in Cardiac Surgery: Coming of Age

Cited by 7 publications

References 61 publications

Combination Therapy in Pulmonary Arterial Hypertension—Targeting the Nitric Oxide and Prostacyclin Pathways

Combination Therapy in Pulmonary Arterial Hypertension—Targeting the Nitric Oxide and Prostacyclin Pathways

How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass

Thomas Bevill Peacock and the First Descriptions of Congenital Heart Disease

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