Maxime Laflamme1, Louis P Perrault1, Michel Carrier1, Mahsa Elmi-Sarabi2, Annik Fortier3, André Y Denault4. 1. Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. 2. Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. 3. Department of Biostatistics, Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Quebec, Canada. 4. Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. Electronic address: andre.denault@gmail.com.
Abstract
OBJECTIVE: To retrospectively evaluate the effects of combined inhaled prostacyclin and milrinone to reduce the severity of pulmonary hypertension when administered prior to cardiopulmonary bypass. DESIGN: Retrospective case control analysis of high-risk patients undergoing cardiac surgery. SETTING: Single cardiac center. PARTICIPANTS: Sixty one adult cardiac surgical patients with pulmonary hypertension, 40 of whom received inhalation therapy. INTERVENTION: Inhaled milrinone and inhaled prostacyclin were administered before cardiopulmonary bypass (CPB). MEASUREMENTS AND MAIN RESULTS: Administration of both inhaled prostacyclin and milrinone was associated with reductions in central venous pressure, and mean pulmonary artery pressure, increases in cardiac index, heart rate, and the mean arterial-to-mean pulmonary artery pressure ratio (p < 0.05), with no significant change in mean arterial pressure. The rate of difficult and complex separation from CPB was 51% in the inhaled group and 70% in the control group (p = 0.1638). Postoperative vasoactive requirement was reduced at 12 hours (35.9 v 73.7% p<0.01) and 24 hours (25.6 v 57.9% p<0.05) postoperatively in the combined inhaled agent group. Hospital length of stay and mortality were similar between the groups. CONCLUSION: Preemptive treatment of pulmonary hypertension with a combination of inhaled prostacyclin and milrinone before CPB was associated with a reduction in the severity of pulmonary hypertension. In addition, a significant reduction in vasoactive support in the intensive care unit during the first 24 hours after cardiac surgery was observed. The impact of this strategy on postoperative survival needs to be determined.
OBJECTIVE: To retrospectively evaluate the effects of combined inhaled prostacyclin and milrinone to reduce the severity of pulmonary hypertension when administered prior to cardiopulmonary bypass. DESIGN: Retrospective case control analysis of high-risk patients undergoing cardiac surgery. SETTING: Single cardiac center. PARTICIPANTS: Sixty one adult cardiac surgical patients with pulmonary hypertension, 40 of whom received inhalation therapy. INTERVENTION: Inhaled milrinone and inhaled prostacyclin were administered before cardiopulmonary bypass (CPB). MEASUREMENTS AND MAIN RESULTS: Administration of both inhaled prostacyclin and milrinone was associated with reductions in central venous pressure, and mean pulmonary artery pressure, increases in cardiac index, heart rate, and the mean arterial-to-mean pulmonary artery pressure ratio (p < 0.05), with no significant change in mean arterial pressure. The rate of difficult and complex separation from CPB was 51% in the inhaled group and 70% in the control group (p = 0.1638). Postoperative vasoactive requirement was reduced at 12 hours (35.9 v 73.7% p<0.01) and 24 hours (25.6 v 57.9% p<0.05) postoperatively in the combined inhaled agent group. Hospital length of stay and mortality were similar between the groups. CONCLUSION: Preemptive treatment of pulmonary hypertension with a combination of inhaled prostacyclin and milrinone before CPB was associated with a reduction in the severity of pulmonary hypertension. In addition, a significant reduction in vasoactive support in the intensive care unit during the first 24 hours after cardiac surgery was observed. The impact of this strategy on postoperative survival needs to be determined.
Authors: Cyrus A Vahdatpour; John J Ryan; Joshua M Zimmerman; Samuel J MacCormick; Harold I Palevsky; Hassan Alnuaimat; Ali Ataya Journal: Heart Fail Rev Date: 2021-09-02 Impact factor: 4.654
Authors: André Y Denault; Jean S Bussières; Ramiro Arellano; Barry Finegan; Paul Gavra; François Haddad; Anne Q N Nguyen; France Varin; Annik Fortier; Sylvie Levesque; Yanfen Shi; Mahsa Elmi-Sarabi; Jean-Claude Tardif; Louis P Perrault; Jean Lambert Journal: Can J Anaesth Date: 2016-07-28 Impact factor: 6.713