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Inhaled NO and Sildenafil Combination in Cardiac Surgery Patients With Out-of-Proportion Pulmonary HypertensionClinical Perspective

D Matamis, S Pampori, A Papathanasiou... - Circulation: Heart ..., 2012 - Am Heart Assoc BackgroundThe goal of this study was to examine the effects of coadministration of sildenafil and inhaled nitric oxide (i NO) in patients with out-of-proportion pulmonary hypertension who underwent cardiac valve replacement surgery.

Methods and Results—Twenty consecutive cardiac surgery patients with out-of-proportion pulmonary hypertension were randomly assigned postoperatively into 2 groups: group A received 10 ppm of i NO followed by sildenafil (100 mg) orally 30 minutes later, and group B initially received sildenafil (100 mg) orally followed by 10 ppm of i NO 60 minutes later. Hemodynamic and gas exchange data were obtained at baseline, after administration of either i NO or sildenafil alone, and at 90 minutes from baseline. In group A, i NO resulted in a significant reduction in mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) (by 9.6% and 20.8%, respectively). In group B, sildenafil administration also resulted in a significant decrease in mean arterial pressure, MPAP, pulmonary artery occlusive pressure, PVRI, and systemic vascular resistance index but also in the Pa O2/inspired fraction of oxygen ratio (by 18.7%, 22.0%, 15.7%, 31.6%, 21.3%, and 14%, respectively). In both groups, the coadministration of the 2 drugs resulted in a significant further reduction of mean arterial pressure, MPAP, pulmonary artery occlusive pressure, systemic vascular resistance index, and PVRI, whereas cardiac index and mixed venous oxygen saturation remained unchanged. The hypoxemia after sildenafil administration in group B improved after the coadministration of i NO, and thus Pa O2/inspired fraction of oxygen returned to values near baseline.