Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 3/2017

Open Access 01-03-2017 | Original Article

A prospective, randomized study of inhaled prostacyclin versus nitric oxide in patients with residual pulmonary hypertension after pulmonary endarterectomy

Authors: Shinichiro Abe, Keiichi Ishida, Masahisa Masuda, Hideki Ueda, Hiroki Kohno, Kaoru Matsuura, Yusaku Tamura, Michiko Watanabe, Goro Matsumiya

Published in: General Thoracic and Cardiovascular Surgery | Issue 3/2017

Login to get access

Abstract

Objectives

Pulmonary endarterectomy (PEA) is an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH), but postoperative residual hypertension leads to in-hospital mortality. Inhaled epoprostenol sodium (PGI2) and NO are administered for pulmonary hypertension after cardiothoracic surgery. This prospective study provides the first comparative evaluation of the effects of inhaled PGI2 and NO on pulmonary hemodynamics, systemic hemodynamics, and gas exchange in patients developing residual pulmonary hypertension after PEA.

Methods

Thirteen patients were randomized to receive either NO (n = 6) or PGI2 (n = 7) inhalation when pulmonary hypertension persisted after weaning from cardiopulmonary bypass. Hemodynamic and respiratory variables were measured before inhalation of the agent (T0); 30 min (T1), 3 h (T2), and 6 h after inhalation (T3); and the next morning (T4). The NO dose was started at 20 ppm and gradually tapered until extubation, and PGI2 was administered at a dose of 10 ng kg−1 min−1.

Results

In both groups, mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) significantly decreased over time until T4 (mean PAP: p < 0.0001; PVR: p = 0.003), while mean systemic arterial blood pressure significantly increased (p = 0.028). There were no significant between-group differences in patient characteristics, cardiac index, left atrial pressure, or ratio of arterial oxygen tension to fraction of inspired oxygen. There were no in-hospital deaths.

Conclusions

Both inhaled PGI2 and NO significantly reduced PAP and PVR without adverse effects on systemic hemodynamics in patients who developed residual pulmonary hypertension after PEA. Inhaled PGI2 can be offered as alternative treatment option for residual pulmonary hypertension.
Literature
1.
Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011–20.CrossRefPubMed
2.
Jamieson SW, Kapelanski DP, Sakakibara N, Manecke GR, Thistlethwaite PA, Kerr KM, et al. Pulmonary endarterectomy: experience and lessons learned in 1500 cases. Ann Thorac Surg. 2003;76:1457–62 (discussion 62–4).CrossRefPubMed
3.
Madani MM, Auger WR, Pretorius V, Sakakibara N, Kerr KM, Kim NH, et al. Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2,700 patients. Ann Thorac Surg. 2012;94:97–103 (discussion 03).CrossRefPubMed
4.
Ishida K, Masuda M, Tanabe N, Matsumiya G, Tatsumi K, Nakajima N. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg. 2012;144:321–6.CrossRefPubMed
5.
Mayer E, Jenkins D, Lindner J, D’Armini A, Kloek J, Meyns B, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg. 2011;141:702–10.CrossRefPubMed
6.
Vuylsteke A, Sharples L, Charman G, Kneeshaw J, Tsui S, Dunning J, et al. Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery (PEACOG): a randomised controlled trial. Lancet. 2011;378:1379–87.CrossRefPubMed
7.
Kramm T, Eberle B, Guth S, Mayer E. Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy. Eur J Cardiothorac Surg. 2005;28:882–8.CrossRefPubMed
8.
Imanaka H, Miyano H, Takeuchi M, Kumon K, Ando M. Effects of nitric oxide inhalation after pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. Chest. 2000;118:39–46.CrossRefPubMed
9.
Miller OI, Tang SF, Keech A, Pigott NB, Beller E, Celermajer DS. Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: a randomised double-blind study. Lancet. 2000;356:1464–9.CrossRefPubMed
10.
Maxey TS, Smith CD, Kern JA, Tribble CG, Jones DR, Kron IL, et al. Beneficial effects of inhaled nitric oxide in adult cardiac surgical patients. Ann Thorac Surg. 2002;73:529–32 (discussion 32–3).CrossRefPubMed
11.
Potapov E, Meyer D, Swaminathan M, Ramsay M, El Banayosy A, Diehl C, et al. Inhaled nitric oxide after left ventricular assist device implantation: a prospective, randomized, double-blind, multicenter, placebo-controlled trial. J Heart Lung Transpl. 2011;30:870–8.
12.
Parquin F, Auriant J, Chajllot A. The use of NO in prevention of reperfusion edema following pulmonary thromboendarterectomy. Am J Respir Crit Care Med. 2002;165:A18.
13.
Jenkins DP, Madani M, Mayer E, Kerr K, Kim N, Klepetko W, et al. Surgical treatment of chronic thromboembolic pulmonary hypertension. Eur Respir J. 2013;41:735–42.CrossRefPubMed
14.
Kramm T, Eberle B, Krummenauer F, Guth S, Oelert H, Mayer E. Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy. Ann Thorac Surg. 2003;76:711–8.CrossRefPubMed
15.
Galie N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:571–6.CrossRefPubMed
16.
Dellinger RP, Zimmerman JL, Taylor RW, Straube RC, Hauser DL, Criner GJ, et al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med. 1998;26:15–23.CrossRefPubMed
17.
Ardehali A, Hughes K, Sadeghi A, Esmailian F, Marelli D, Moriguchi J, et al. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation. 2001;72:638–41.CrossRefPubMed
18.
De Wet CJ, Affleck DG, Jacobsohn E, Avidan MS, Tymkew H, Hill LL, et al. Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery. J Thorac Cardiovasc Surg. 2004;127:1058–67.CrossRefPubMed
19.
Hache M, Denault A, Belisle S, Robitaille D, Couture P, Sheridan P, et al. Inhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery. J Thorac Cardiovasc Surg. 2003;125:642–9.CrossRefPubMed
20.
Sablotzki A, Hentschel T, Gruenig E, Schubert S, Friedrich I, Muhling J, et al. Hemodynamic effects of inhaled aerosolized iloprost and inhaled nitric oxide in heart transplant candidates with elevated pulmonary vascular resistance. Eur J Cardiothorac Surg. 2002;22:746–52.CrossRefPubMed
21.
Khan TA, Schnickel G, Ross D, Bastani S, Laks H, Esmailian F, et al. A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients. J Thorac Cardiovasc Surg. 2009;138:1417–24.CrossRefPubMed
22.
Winterhalter M, Simon A, Fischer S, Rahe-Meyer N, Chamtzidou N, Hecker H, et al. Comparison of inhaled iloprost and nitric oxide in patients with pulmonary hypertension during weaning from cardiopulmonary bypass in cardiac surgery: a prospective randomized trial. J Cardiothorac Vasc Anesth. 2008;22:406–13.CrossRefPubMed
23.
Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K, et al. Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. J Cardiothorac Vasc Anesth. 2013;27:459–66.CrossRefPubMed
24.
Flondor M, Merkel M, Hofstetter C, Irlbeck M, Frey L, Zwissler B. The effect of inhaled nitric oxide and inhaled iloprost on hypoxaemia in a patient with pulmonary hypertension after pulmonary thrombarterectomy. Anaesthesia. 2006;61:1200–3.CrossRefPubMed
25.
van Heerden PV, Barden A, Michalopoulos N, Bulsara MK, Roberts BL. Dose-response to inhaled aerosolized prostacyclin for hypoxemia due to ARDS. Chest. 2000;117:819–27.CrossRefPubMed
Metadata
Title
A prospective, randomized study of inhaled prostacyclin versus nitric oxide in patients with residual pulmonary hypertension after pulmonary endarterectomy
Authors
Shinichiro Abe
Keiichi Ishida
Masahisa Masuda
Hideki Ueda
Hiroki Kohno
Kaoru Matsuura
Yusaku Tamura
Michiko Watanabe
Goro Matsumiya
Publication date
01-03-2017
Publisher
Springer Japan
Published in
General Thoracic and Cardiovascular Surgery / Issue 3/2017
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-016-0724-2

Other articles of this Issue 3/2017

General Thoracic and Cardiovascular Surgery 3/2017 Go to the issue

Case Report

Left ventricular outflow tract obstruction masked by severe aortic stenosis

Review Article

Development of the Maze procedure and the contribution of Japanese surgeons

Case Report

A case of mediastinal abscess in a hemodialysis patient

Current Topics Review Article

Posterior ventricular restoration treatment for heart failure: a review, past, present and future aspects

Case Report

Resection of pulmonary endometriosis using video-assisted thoracoscopic surgery under preoperative CT-guided marking

Case Report

Pulmonary artery sarcoma presenting as an isolated lung mass