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Sildenafil and beraprost combination therapy in patients with pulmonary hypertension undergoing valvular heart surgery

 So Yeon Kim  ;  Jae Kwang Shim  ;  Yeon Hee Shim  ;  Seong Wook Hong  ;  Kil Hwan Choi  ;  Young Lan Kwak 
 JOURNAL OF HEART VALVE DISEASE, Vol.19(3) : 333-340, 2010 
Journal Title
Issue Date
Adult ; Aged ; Anesthesia, General ; Blood Pressure/drug effects ; Comorbidity ; Drug Therapy, Combination ; Epoprostenol/administration & dosage ; Epoprostenol/analogs & derivatives* ; Epoprostenol/therapeutic use ; Female ; Heart Valve Diseases/epidemiology* ; Heart Valve Diseases/surgery* ; Hemodynamics ; Humans ; Hypertension, Pulmonary/drug therapy* ; Hypertension, Pulmonary/epidemiology ; Hypertension, Pulmonary/physiopathology ; Male ; Middle Aged ; Piperazines/administration & dosage ; Piperazines/therapeutic use* ; Preoperative Care ; Purines/administration & dosage ; Purines/therapeutic use ; Sildenafil Citrate ; Sulfones/administration & dosage ; Sulfones/therapeutic use* ; Vascular Resistance/drug effects ; Vasoconstrictor Agents/therapeutic use ; Vasodilator Agents/administration & dosage ; Vasodilator Agents/therapeutic use*
BACKGROUND AND AIM OF THE STUDY: Sildenafil and beraprost, as orally available pulmonary vasodilators, are used increasingly to treat pulmonary hypertension (PH). An evaluation was made, in patients with PH undergoing valvular heart surgery, as to whether preoperative combined oral sildenafil and beraprost treatment could induce synergistic and prolonged pulmonary vasodilation, or result in a loss of pulmonary selectivity.
METHODS: Fifty patients scheduled for valvular heart surgery with a mean pulmonary arterial pressure (PAP) > 30 mmHg were randomly assigned to receive either 50 mg oral sildenafil + 40 microg beraprost, or a placebo, 15 min before the induction of anesthesia. Hemodynamic variables were measured intraoperatively.
RESULTS: The treatment group had a significantly lower systemic vascular resistance index at 60 min after medication. No other significant intergroup differences in hemodynamic variables were observed. In addition, significantly more patients in the treatment group required vasopressor therapy. In both groups, the PAP was significantly reduced by general anesthesia, and almost normalized after valvular heart surgery.
CONCLUSION: Preoperative oral sildenafil and beraprost treatment resulted in a loss of pulmonary selectivity, and did not provide any additional pulmonary vasodilation or favorable perioperative hemodynamics in patients with PH undergoing valvular heart surgery.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Shim, Yon Hee(심연희) ORCID logo https://orcid.org/0000-0003-1921-3391
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
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