Comparison of Inhaled Nitric Oxide Versus Oxygen on Hemodynamics in Patients With Mitral Stenosis and Severe Pulmonary Hypertension After Mitral Valve Surgery

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• 作者：Juliano L. Fernandes MD ; PhD ; ^a ; ^{jlaraf@terra.com.br} ; Roney O. Sampaio MD ; PhD^a ; Carlos M. Brandã ; o MD^a ; Tarso Augusto D. Accorsi MD^a ; Luiz F. Cardoso MD ; PhD^a ; Guilherme S. Spina MD ; PhD^a ; Flavio Tarasoutchi MD ; PhD^a ; Pablo Pomerantzeff MD ; PhD^a ; Jose O. Auler Jr. MD ; PhD^a ; Max Grinberg MD ; PhD^a
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：1 April 2011
• 年：2011
• 卷：107
• 期：7
• 页码：1040-1045
• 全文大小：593 K

文摘

Pulmonary hypertension represents an important cause of morbidity and mortality in patients with mitral stenosis who undergo cardiac surgery, especially in the postoperative period. The aim of this study was to test the hypothesis that inhaled nitric oxide (iNO) would improve the hemodynamic effects and short-term clinical outcomes of patients with mitral stenosis and severe pulmonary hypertension who undergo cardiac surgery in a randomized, controlled study. Twenty-nine patients (4 men, 25 women; mean age 46 ± 2 years) were randomly allocated to receive iNO (n = 14) or oxygen (n = 15) for 48 hours immediately after surgery. Hemodynamic data, the use of vasoactive drugs, duration of stay, and short-term complications were assessed. No differences in baseline characteristics were observed between the groups. After 24 and 48 hours, patients receiving iNO had a significantly greater increase in cardiac index compared to patients receiving oxygen (p <0.0001). Pulmonary vascular resistance was also more significantly reduced in patients receiving iNO versus oxygen (−117 dyne/s/cm⁵, 95 % confidence interval −34 to −200, vs 40 dyne/s/cm⁵, 95 % confidence interval −34 to 100, p = 0.005) at 48 hours. Patients in the iNO group used fewer systemic vasoactive drugs (mean 2.1 ± 0.14 vs 2.6 ± 0.16, p = 0.046) and had a shorter intensive care unit stay (median 2 days, interquartile range 0.25, vs median 3 days, interquartile range 7, p = 0.02). In conclusion, iNO immediately after surgery in patients with mitral stenosis and severe pulmonary hypertension improves hemodynamics and may have short-term clinical benefits.