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Category: Volume 08 Issue 04 April 2020
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Title: Effect of preoperative oral sildenafil on intraoperative hemodynamics in patients with severe pulmonary artery hypertension undergoing mitral valve replacement

Authors: Vijay Shewale, Manish Jadhao, Vaibhav Shah, Chaitanya Raut, Prashant Mishra, Jayant Khandekar

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.51

Abstract

   

Aim: Long standing severe mitral stenosis or mitral regurgitation is usually associated with pulmonary hypertension. Severe pulmonary hypertension is a risk factor for right ventricular dysfunction and is associated with morbidity and mortality in patients undergoing mitral valve surgery. Sildenafil is selective phosphodiesterase type 5 inhibitor which is increasingly used for pulmonary hypertension. But there is lack of evidence of its usefulness in pulmonary hypertension due to mitral valve disease. The study aims to assess the effectiveness of preoperative oral sildenafil on severe pulmonary hypertension and incidence of RV failure in patients undergoing mitral valve replacement surgery.

Materials & Methods: A total of 50 patients scheduled for mitral valve replacement with severe pulmonary hypertension (pulmonary artery pressure greater than 30 mm of hg) on preoperative transthoracic echo  who got operated during January 2019 to march 2019 , were randomly treated with oral sildenafil 25 mg (N = 25) or placebo (N = 25) eight hourly for 48 hours before surgery. Hemodynamic  variables were measured 5 minutes after induction of anaesthesia (T1-baseline), 30 minutes at weaning from cardiopulmonary bypass (CPB) (T2) and after 1,2, and 6 hours (T3, T4, T5, respectively) during the postoperative period.

Result: Patient characteristics and baseline hemodynamics were similar between groups. Systolic and mean pulmonary arterial pressures and pulmonary vascular resistance were significantly lower in the sildenafifil group at all times without any changes in mean systemic arterial pressure and systemic vascular resistance. Ventilation time and postoperative recovery room stay were significantly lower in sildenafil group.

Conclusion: Sildenafil has significant vasodilatory effect on pulmonary vessels as compared with placebo in mitral valve replacement patients with severe pulmonary hypertension. It also reduces ventilation time and intensive care unit (ICU) stay time as compared with placebo. It is concluded that sildenafil is effective in reducing pulmonary hypertension when administered preoperatively in patients with severe pulmonary hypertension undergoing mitral valve replacement surgery.

Keywords: Sildenafil, Pulmonary Hypertension, Mitral Valve Replacement, Pulmonary Hemodynamics.

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Corresponding Author

Vijay Shewale

Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India