Introduction: An acute pulmonary hypertensive crisis is a dreaded complication in the immediate post operative period.We assessed whether pretreatment with sildenafil and or milrinone before cardiac surgery would have any impact on the number and severity of postoperative hypertensive crisis.
Aims and objectives: To assess the number and severity of pulmonary hypertensive crisis in children undergoing repair of CHD with pulmonary hypertension who were pretreated with chronic phosphodiesterase inhibitor therapy
Preoperative:
PDE group
40 consecutive children undergoing surgery for CHD with PA pressures more than 50% systemic , were included in the study group.Patients were given sildenafil in a dose of 0.5mg/kg/dose 6 hourly prior to surgery. Children who required surgery soon after diagnosis received IV milrinone (0.5mcg/kg/min,no loading) with or without sildenafil.
Control group: 33 historical age, weight, diagnosis matched controls who underwent repair before the study period. They did not receive phosphodiesterase inhibitors prior to surgery
The primary end points were 1)Number of crisis 2)Episodes of increased PA pressures to 75% systemic or more not requiring intervention 3)3. Death presumed to be due to crisis.
Results: Patients in the PDE group received either received sildenafil (n=39) or milrinone (n=1) or both(n=10). The duration therapy was 29 days(SD 52.6) for sildenafil and 1.5 days(SD 0.9) for milrinone.
Other data are included in the table
Conclusions:Pretreatment with phosphodiesterase inhibitors increases the odds of not having a postoperative pulmonary hypertensive crisis(NNT=4),increases the odds of tolerating high PA pressures without a crisis(NNT=3),and the odds of survival(OR=3.3).

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