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Inhaled iloprost controls pulmonary hypertension after cardiopulmonary bypass

[L’inhalation d’iloprost permet de contrôler l’hypertension pulmonaire après la circulation extracorporelle]

Kassiani Theodoraki, MD DEAA^*, Panagiota Rellia, MD^*, Apostolos Thanopoulos, MD^*, Loukas Tsourelis, MD, Dimitrios Zarkalis, MD, Petros Sfyrakis, MD and Theophani Antoniou, MD^*

^* From the Department of Anesthesiology, and the 1^st Cardiosurgery Division,
Onassis Cardiac Surgery Centre, Athens, Greece.

Address correspondence to: Dr. Kassiani Theodoraki, Papanastassiou 105, 104 45 Athens, Greece. Phone: 30-10 2112672; E-mail: ktheodoraki{at}hotmail.com

Purpose: Severe pulmonary hypertension (PH) is a major cause of right ventricular (RV) dysfunction. Various iv vasodilator modalities have been used with limited results because of lack of pulmonary selectivity. The aim of the present controlled study was to evaluate the efficacy of inhaled iloprost, a synthetic prostacyclin analogue, in patients with elevated pulmonary vascular resistance (PVR) immediately after separation from cardiopulmonary bypass (CPB).

Methods: Twelve patients with persistent PH after discontinuation of CPB were included in the study. In all patients standard hemodynamic monitoring was used. Inhaled iloprost was administered via nebulized aerosol at a cumulative dose of 0.2 µg•kg^–1 for a total duration of 20 min. Complete sets of hemodynamic measurements were performed before inhalation (baseline), during and after cessation of the inhalation period. Echocardiographic monitoring of RV function was also used.

Results: Inhaled iloprost induced a reduction in the transpulmonary gradient at the end of the inhalation period in comparison to baseline (9.33 ± 3.83 mmHg vs 17.09 ± 6.41 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.28 ± 0.08 vs 0.45 ± 0.17, P < 0.05). A statistically significant decrease of the PVR to systemic vascular resistance ratio was also observed (0.15 ± 0.05 vs 0.21 ± 0.05, P < 0.05). Improved indices of RV function were observed in echocardiographic monitoring.

Conclusion: Inhaled iloprost appears to be a selective pulmonary vasodilator and may be effective in the initial treatment of PH and the improvement of RV performance in the perioperative setting.

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