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Eur J Cardiothorac Surg 2005;28:882-888
© 2005 Elsevier Science NL

Inhaled iloprost to control residual pulmonary hypertension following pulmonary endarterectomy

^a Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Medical School, Langenbeckstr. 1, D-55131 Mainz, Germany
^b Department of Anesthesiology, Johannes Gutenberg University Medical School, D-55131 Mainz, Germany

Received 17 April 2005; received in revised form 5 September 2005; accepted 7 September 2005.

^_* Corresponding author. Tel.: +49 6131 17 2106; fax: +49 6131 17 6626. (Email: kramm{at}mail.uni-mainz.de).

Objective: Pulmonary endarterectomy (PEA) is the standard therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In the immediate postoperative period, persistent pulmonary hypertension increases the risk of acute respiratory or right heart failure. In pulmonary arterial hypertension, prostanoid inhalation has been found to improve pulmonary hemodynamics, right ventricular function, gas exchange, and clinical outcome. We report the results of a double-blinded randomized trial with the aerosolized prostacyclin analogue iloprost in patients with residual pulmonary hypertension after PEA. Methods: Twenty-two patients (age, 55 ± 13 years; 8 females; propofol- and sufentanil-based anesthesia; pressure-controlled mechanical ventilation) were randomized to receive either a single dose of 25 µg aerosolized iloprost (iloprost group; n = 11) or normal saline (placebo group; n = 11) immediately after postoperative ICU admission. Primary endpoints were changes in gas exchange, pulmonary and systemic hemodynamics, and clinical outcome. Results: Iloprost significantly enhanced cardiac index (CI) and reduced mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance [PVR (dyn s cm^–5)] in contrast to placebo. Placebo: pre-inhalation 413 ± 195 versus post-inhalation 404 ± 196 at 30 min (p = 0.051), 415 ± 189 at 90 min (p = 0.929). Iloprost: pre-inhalation 503 ± 238 versus post-inhalation 328 ± 215 at 30 min (p = 0.001), 353 ± 156 at 90 min (p = 0.003). Blood oxygenation remained unchanged. Conclusion: In addition to the effect of PEA, iloprost reduces residual postoperative pulmonary hypertension, decreases right ventricular afterload and may facilitate the early postoperative management after PEA.

Key Words: Hypertension • Pulmonary • Prostanoid • Pulmonary endarterectomy

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