Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery

Abstract

Pulmonary hypertension represents an important cause of morbidity and mortality in patients with mitral stenosis who undergo cardiac surgery, especially in the postoperative period. The aim of this study was to test the hypothesis that inhaled nitric oxide (iNO) would improve the hemodynamic effects and short-term clinical outcomes of patients with mitral stenosis and severe pulmonary hypertension who undergo cardiac surgery in a randomized, controlled study. Twenty-nine patients (4 men, 25 women; mean age 46 ± 2 years) were randomly allocated to receive iNO (n = 14) or oxygen (n = 15) for 48 hours immediately after surgery. Hemodynamic data, the use of vasoactive drugs, duration of stay, and short-term complications were assessed. No differences in baseline characteristics were observed between the groups. After 24 and 48 hours, patients receiving iNO had a significantly greater increase in cardiac index compared to patients receiving oxygen (p <0.0001). Pulmonary vascular resistance was also more significantly reduced in patients receiving iNO versus oxygen (-117 dyne/s/cm(5), 95% confidence interval -34 to -200, vs 40 dyne/s/cm(5), 95% confidence interval -34 to 100, p = 0.005) at 48 hours. Patients in the iNO group used fewer systemic vasoactive drugs (mean 2.1 ± 0.14 vs 2.6 ± 0.16, p = 0.046) and had a shorter intensive care unit stay (median 2 days, interquartile range 0.25, vs median 3 days, interquartile range 7, p = 0.02). In conclusion, iNO immediately after surgery in patients with mitral stenosis and severe pulmonary hypertension improves hemodynamics and may have short-term clinical benefits.

Inhaled nitric oxide in cardiac surgery: Evidence or tradition?

“…These continue to demonstrate biological benefits, hemodynamically important physiological benefit and have begun to demonstrate some meaningful clinical outcomes such as reduction in duration of mechanical ventilation and stay in the intensive care unit (74)(75)(76)(77)(78)(79)(80). However, these studies remain to involve only a limited surgical patient population, have not progressed beyond single institutional boundaries and lack any demonstration of survival benefit.…”

Results of Mitral Valve Surgery with Pulmonary Arterial Hypertension: Analysis of a Retrospective Study

“…We have used, for some patients with residual PAH, difficult to extubate postoperatively, sildenafil which has given excellent results [31][32][33]; we have never used other pulmonary vasodilators (prostaglandins E1, NO) due to the unavailability of these products in our country.…”

Pharmacologic Management of Perioperative Pulmonary Hypertension

“…Inhaled NO has also been effective for treatment in the adult population [20–23]. Inhaled NO significantly reduced PAP and increased cardiac index and systemic blood pressure in high-risk cardiac surgery patients [20–22]. It was also effective in improving RV ejection fraction and reducing the need for vasopressor treatment [22,23].…”