Hasan SUNAR, Taylan ADADEMİR, Naci ÖNER, Mehmet ÖZKÖKELİ, Rahmi ZEYBEK, Ahmet ŞAŞMAZEL, Ekrem YILMAZ, Ayşe BAYSAL

Doğuştan kalp cerrahisi sonrası inhale nitrik oksit tedavisinin kesilmesine yardımcı oral sildenafil kullanımı: Klinik deneyimlerimiz

Amaç: Bu çalışmada ciddi pulmoner hipertansiyon hastalarında, doğuştan kalp cerrahisi sonrası inhale nitrik oksit (iNO) tedavisinin sonlandırılmasında profilaktik oral sildenafil kullanılmasının sonuçları değerlendirildi. Çalışma planı: Ameliyat sırasında iNO tedavisi başlanan 21 hastadan 18’inde ameliyat sonrası birinci günde tedaviye sildenafil (1 mg/kg, günde 4 kez) eklendi. Hastaların tıbbi kayıtları rebound pulmoner arteriyel hipertansiyon kliniği, entübasyon süresi, yoğun bakımda kalış süreleri ve erken ve geç dönem mortalite açısından geriye dönük olarak değerlendirildi. Bulgular: Sildenafil tedavi protokolünün uygulandığı 18 hastanın dördünde (%22.2) erken mortalite görüldü. İki ölüm (%11.1) ameliyat sonrası birinci günde düşük kalp debisi nedeniyle, diğer iki ölüm (%11.1) ise ciddi rebound pulmoner hipertansiyon krizi nedeniyle ameliyat sonrası altı ve dokuzuncu günlerde gerçekleşti. On dört hastada da (%77.8) oral sildenafil tedavisi ile iNO kullanımının sonlandırılması rebound pulmoner hipertansiyon krizine yol açmadı. Sonuç: Doğuştan kalp cerrahisi sonrası iNO tedavisinden ayırmaya yardımcı olma amaçlı profilaktik sildenafil kullanımı, rebound pulmoner hipertansiyonun engellenmesinde yararlı olabilir. Profilaktik uygulamanın etkinliği ve güvenirliğinin değerlendirilmesi için randomize kontrollü çalışmalara gereksinim vardır.

Use of oral sildenafil to facilitate weaning from inhaled nitric oxide following congenital heart surgery: our clinical experiences

Background: This study aims to evaluate the results of the prophylactic use of oral sildenafil in weaning from inhaled nitric oxide (iNO) treatment following congenital cardiac surgery in severe pulmonary hypertensive patients. Methods: Oral sildenafil (1 mg/kg, 4 times daily) was added to the treatment of 18 of 21 patients who had started iNO therapy intraoperatively, on the postoperative first day. The medical records of the patients were retrospectively evaluated with respect to the clinical status of rebound pulmonary artery hypertension, entubation time, duration of intensive care unit stay, and early and late mortality. Results: Early mortality was seen in four (22.2%) of 18 patients with the sildenafil treatment protocol. Two (11.1%) deaths were due to low cardiac output on the postoperative first day, and the remaining two (11.1%) deaths were due to severe rebound pulmonary hypertensive crisis on the postoperative sixth and ninth days. In 14 (77.8%) of the patients, no rebound pulmonary hypertensive crisis was seen after the discontinuation of iNO with the oral sildenafil treatment. Conclusion: The prophylactic use of sildenafil to facilitate iNO withdrawal can be beneficial in the prevention of rebound pulmonary hypertension following congenital cardiac surgery. Randomized controlled trials are needed to evaluate the safety and efficacy of the prophylactic use.

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