Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery

Wet, Charl J. De; Affleck, David G.; Jacobsohn, Eric; Avidan, Michael S.; Tymkew, Heidi; Hill, Laureen L.; Zanaboni, Paul; Moazami, Nader; Smith, Jennifer

doi:10.1016/j.jtcvs.2003.11.035

Cited by 153 publications

(71 citation statements)

References 31 publications

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“…Advances in the treatment of PH such as prostacyclin, intravenous milrinone, inhaled nitric oxide, sildenafil, and other modalities have ameliorated some of the physiologic consequences of PH 12-14. Almost half of patients undergoing surgery for aortic stenosis have PH (in both this and other studies), 4, 6, 9 and therefore continued efforts to improve the treatment of these patients is warranted.…”

Section: Discussionmentioning

confidence: 74%

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Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

Melby

Moon

Lindman

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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151

129

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Objective The presence of pulmonary hypertension (PH) historically has been considered a significant risk factor affecting early and late outcomes following valve replacement. Given the number of recent advances in the management of PH following cardiac surgery a better understanding of the impact of PH on outcomes may assist in the clinical management of these patients. The purpose of this study was to determine if pulmonary hypertension remains a risk factor in the modern era for adverse outcomes following aortic valve replacement (AVR) for aortic valve stenosis. Methods From January 1996 to June 2009, 1,080 patients underwent AVR for primary aortic valve stenosis, of which 574 (53%) had normal systolic pulmonary artery pressures (sPAP) and 506 (47%) had PH. PH was defined as mild (sPAP 35-44 mmHg), moderate (45-59mmHg), or severe (≥ 60mmHg). In the group of patients with PH, 204 had postoperative echocardiograms. Results Operative mortality was significantly higher in patients with PH (47/506, 9% versus 31/574, 5%; p=0.02). The incidence of postoperative stroke was similar (p=0.14), but patients with PH had an increased median hospital LOS (8 versus 7 days, p=0.001) and an increased incidence of prolonged ventilation (26% versus 17%, p<0.001). Preoperative PH was an independent risk factor for decreased long term survival (RR 1.7, p=0.02). Those with persistent PH postoperatively had decreased survival. Five-year survival (Kaplan-Meier) was 78 ± 6% with normal sPAP and 77 ± 7% with mild PH postoperatively, compared to 64 ± 8% with moderate PH and 45 ± 12% with severe PH (p<0.001). Conclusion In patients undergoing AVR, preoperative PH increased operative mortality and decreased long-term survival. Patients with persistent moderate or severe PH after AVR had decreased long-term survival. These data suggest that PH had a significant impact on outcomes in patients undergoing AVR and should be considered in preoperative risk assessment.

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Section: Discussionmentioning

confidence: 74%

“…The EuroSCORE uses only the presence of severe PH (PAP > 60 mm Hg) and the STS risk calculator does not consider PH at all. 10-12…”

Section: Discussionmentioning

confidence: 99%

Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

Melby

Moon

Lindman

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

151

129

View full text Add to dashboard Cite

show abstract

“…[373839] In a retrospective study of 33 adult ICU patients with hypoxemia and PH from cardiac and noncardiac causes, inhaled prostacyclin improved mPAP and hypoxemia. [40] Other studies and case reports have demonstrated the utility of inhaled prostacyclin and of the prostacyclin analog, iloprost, in reducing PAP and improving cardiac output,[414243] although prospective studies in critically ill patients with PH are lacking.…”

Section: Pharmacologic Therapy Of Pulmonary Hypertensionmentioning

confidence: 99%

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Intensive care management of pulmonary hypertension

Al-Azem¹,

Al-Hazmi²

2014

Ann Thorac Med

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Pulmonary hypertension (PH) in the Intensive Care Unit (ICU) may be due to preexisting pulmonary vascular lung disease, liver disease, or cardiac diseases. PH also may be caused by critical illnesses, such as acute respiratory distress syndrome (ARDS), acute left ventricular dysfunction and pulmonary embolism, or may occur after cardiac or thoracic surgery.Regardless of the underlying cause of PH, the final common pathway for hemodynamic deterioration and death is RV failure, which is the most challenging aspect of patient management. Therapy is thus aimed at acutely relieving RV overload by decreasing PVR and reversing RV failure with pulmonary vasodilators and inotropes.

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“…iNO reduces PAPs and pulmonary vascular resistance, while it does not produce systemic vasodilation, since it is rapidly inactivated by hemoglobin binding. [67103104105106107] PH-specific therapies, used in the perioperative period, include oral or IV sildenafil,[13108109] IV or inhaled epoprostenol,[110111112113114115] inhaled iloprost,[116117118] and IV treprostinil. [119] Endothelin receptor antagonists have a limited role in the acute setting as they are considered long-term therapies for PH.…”

Section: Managementmentioning

confidence: 99%

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Perioperative management in patients with pulmonary hypertension

Tonelli

Minai

2014

Ann Thorac Med

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Patients with pulmonary hypertension (PH) are being encountered more commonly in the perioperative period and this trend is likely to increase as improvements in the recognition, management, and treatment of the disease continue to occur. Management of these patients is challenging due to their tenuous hemodynamic status. Recent advances in the understanding of the patho-physiology, risk factors, monitoring, and treatment of the disease provide an opportunity to reduce the morbidity and mortality associated with PH in the peri-operative period. Management of these patients requires a multi-disciplinary approach and meticulous care that is best provided in centers with vast experience in PH.In this review, we provide a detailed discussion about oerioperative strategies in PH patients, and give evidence-based recommendations, when applicable.

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Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery

Cited by 153 publications

References 31 publications

Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Intensive care management of pulmonary hypertension

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Perioperative management in patients with pulmonary hypertension

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