Sildenafil and beraprost combination therapy in patients with pulmonary
hypertension undergoing valvular heart surgery.
Author(s): Kim SY(1), Shim JK, Shim YH, Hong SW, Choi KH, Kwak YL.
Affiliation(s): Author information:
(1)Department of Anesthesiology and Pain Medicine, Yonsei University College of
Medicine, Seoul, Korea.
Publication date & source: 2010, J Heart Valve Dis. , 19(3):333-40
BACKGROUND AND AIM OF THE STUDY: Sildenafil and beraprost, as orally available
pulmonary vasodilators, are used increasingly to treat pulmonary hypertension
(PH). An evaluation was made, in patients with PH undergoing valvular heart
surgery, as to whether preoperative combined oral sildenafil and beraprost
treatment could induce synergistic and prolonged pulmonary vasodilation, or
result in a loss of pulmonary selectivity.
METHODS: Fifty patients scheduled for valvular heart surgery with a mean
pulmonary arterial pressure (PAP) > 30 mmHg were randomly assigned to receive
either 50 mg oral sildenafil + 40 microg beraprost, or a placebo, 15 min before
the induction of anesthesia. Hemodynamic variables were measured
intraoperatively.
RESULTS: The treatment group had a significantly lower systemic vascular
resistance index at 60 min after medication. No other significant intergroup
differences in hemodynamic variables were observed. In addition, significantly
more patients in the treatment group required vasopressor therapy. In both
groups, the PAP was significantly reduced by general anesthesia, and almost
normalized after valvular heart surgery.
CONCLUSION: Preoperative oral sildenafil and beraprost treatment resulted in a
loss of pulmonary selectivity, and did not provide any additional pulmonary
vasodilation or favorable perioperative hemodynamics in patients with PH
undergoing valvular heart surgery.
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