The Effects of Perioperative Inhaled Iloprost on Pulmonary Hypertension with Congenital Heart Disease

Abstract

Objectives: The treatment of choice for congenital heart disease (CHD) with pulmonary arterial hypertension (PAH) is still controversial. We assessed the efficacy and safety of perioperative inhaled iloprost therapy in CHD with PAH. Methods: Among 45 patients with a ventricular septal defect and/or an atrial septal defect with PAH, 28 patients were treated with inhaled iloprost before and after surgery. Perioperative clinical parameters and plasma B-type natriuretic peptide (BNP) were evaluated. Results: No statistical difference in the estimated right ventricular systolic pressure (e-RVP), the e-RVP-to-systemic pressure ratio, and preoperative BNP levels between the iloprost group and the control group were found. Among the iloprost group, oxygen saturation was increased significantly after iloprost inhalation therapy (p = 0.0052). The iloprost group was also significantly correlated with less use of inhaled nitric oxide in the immediate postoperative period compared to the control group (p = 0.021). The durations of mechanical ventilation (p = 0.018), ICU stay (p = 0.005), and chest tube use (p = 0.039) were significantly shorter in the iloprost group compared to the control group. The plasma BNP, checked on 7th day of postoperatively, was lower in the iloprost group than in the control group (p = 0.008). Conclusion: Perioperative inhaled iloprost therapy showed the benefit of cardiac functional improvement and early weaning of postoperative supportive care in the management of CHD with PAH.

Long-term results of surgical repair of congenital heart defects in children with severe pulmonary arterial hypertension treated with perioperative inhaled iloprost

“…Inhaled iloprost is a stable prostacyclin and can be used in children with pulmonary arterial hypertension. [3,4,6] In the present study, we aimed to evaluate the longterm outcomes of patients with PAH and congenital heart disease (CHD) treated with inhaled iloprost perioperatively.…”

“…Formal hemodynamic assessment with vasoreactivity testing is also important, as patients with lower preoperative PVR and evidence of significant vasoreactivity are likely to be better surgical candidates. Sung et al [15] strongly recommended pretreatment with advanced therapies such as iloprost and tolerance to long-term administration before surgery.…”

Current therapy of Eisenmenger syndrome

“…A retrospective study of adult patients with PAH to CHD in Korea also suggested that inhaled iloprost as a perioperative medical intervention for patients with PAH-CHD is safe and effective in improving the systemic oxygen saturation and for early recovery in the postoperative course ( Table 2) (12). Also, a prospective single-arm study which 18 patients with ES and exertional dyspnea according to WHO functional class III or IV were prospectively recruited had showed that 24 weeks of inhaled iloprost therapy in patients with ES led to significant improvements in exercise capacity, quality of life, and right ventricular function.…”

Eisenmenger's Syndrome: In Search of the Best Vasodilator

“…In a study published in this issue of Cardiology , Sung et al [12] compared the effects of perioperative iloprost inhalation in a mixed cohort of 28 children and adults with an atrial or ventricular septal defect to a historical cohort of 17 patients who had been previously operated at the same hospital. Inhaled iloprost was administered prior to surgical correction for an average of 9.7 days with the intention of improving preoperative hemodynamics and oxygenation, and for an average of 4.4 days after surgery to reduce the incidence and severity of postoperative complications.…”

“…While the findings by Sung et al [12] highlight the potential benefits of perioperative iloprost inhalation in congenital heart surgery, caution is warranted when advocating a generalization of this strategy. First, it should be kept in mind that the present findings were derived from a retrospective analysis of a treatment cohort against the background of a historical control.…”