Inhaled iloprost In Control Of Postoperative Inhaled iloprost In Control Of Postoperative Pulmonary Hypertension After Pediatric Cardiac Surgery:A One Year, Single Center, Open Label Pilot Trial

  • Xiaoman Cai, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Zhuoming Xu, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Jinfen Liu, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Zhenying Shi, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Limin Zhu, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Xinrong Liu, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China
  • Zhaokang Su, Department of cardiovascular surgery, Shanghai Children’s Medical Center, Medical college of Shanghai Jiaotong University, China

    • Abstract
    Objectives
    Pulmonary hypertension is a major postoperative complication in children with congenital heart disease (CHD) and has significant impact on morbidity and mortality in the postoperative period. The aerosolized administration of the prostacyclin analogue iloprost is a alternative with pulmonary-selective vasodilation and virtually no systemic side-effects. The aim was to evaluate the efficacy of inhaled iloprost for treatment of PH after CHD repair in children.
    Methods
    During January 2008-December 2008, 46 pts with mean age of 13.7±28.8 month(range 0.8-132 months) and significant postoperative PH (Pp/Ps≥0.5 or mPAP≥30mmHg) after repair of CHD (Table 1). PH was evaluated through PA line and/or echocardiography. Inhaled iloprost was administered via nebulized aerosol at a dose of 50ng/kg/min lasting 10 min q2h to q6h.
    Result
    All patients were weaned off ventilators successfully in CICU and no drug related complications happened. The duration of mechanical ventilation was 53.8±36.1hr and CICU stay was 6.1±3.6 days. The reintubation rate was 7.2% (3 pts) for pulmonary infection. One patient dead (hospital mortality was 2.4%) due to LCOS. Inhaled iloprost induced a statistically reduction mPAP at the end of the inhalation period in comparison to baseline (P < 0.05). The Pp/Ps ratio decreased over this period (P<0.05). There were no change in HR and ABP during inhalation (Table 2).
    Conclusion:
    Inhaled iloprost appears to be a selective pulmonary vasodilator and may be effective in the treatment of postoperative PH after Paediatric Cardiac Surgery.