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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

26.12.2023 | Reports of Original Investigations

Inhaled iloprost in off-pump coronary artery bypass surgery: a randomized controlled trial

verfasst von: Seo Hee Ko, MD, Jae-Kwang Shim, MD, PhD, Jong-Wook Song, MD, PhD, Sarah Soh, MD, PhD, Young-Lan Kwak, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 4/2024

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Abstract

Purpose

Mechanical cardiac constraint during off-pump coronary artery bypass surgery (OPCAB) causes right ventricle (RV) compression and increased pulmonary artery pressure (PAP), which may further compromise RV dysfunction. We aimed to assess the effect of inhaled iloprost, a potent selective pulmonary vasodilator, on the cardiac index (CI) during mechanical constraint. The secondary aim was to determine the resultant changes in the hemodynamic and respiratory parameters.

Methods

A total of 100 adult patients with three-vessel coronary artery disease who had known risk factors for hemodynamic instability (congestive heart failure, mean PAP ≥ 25 mm Hg, RV systolic pressure ≥ 50 mm Hg on preoperative echocardiography, left ventricular ejection fraction < 50%, myocardial infarction within one month of surgery, redo surgery, and left main disease) were enrolled in a randomized controlled trial. The patients were randomly allocated to the control or iloprost groups at a 1:1 ratio, in which saline and iloprost (20 μg) were inhaled for 15 min after internal mammary artery harvesting, respectively. Cardiac index was measured by pulmonary artery catheterization.

Results

There were no significant intergroup differences in CI during grafting (P = 0.36). The mean PAP had a significant group-time interaction (P = 0.04) and was significantly lower in the iloprost group at circumflex grafting (mean [standard deviation], 26 [3] mm Hg vs 24 [3] mm Hg; P = 0.01). The remaining hemodynamic parameters were similar between the groups.

Conclusion

Inhaled iloprost showed a neutral effect on hemodynamic parameters, including the CI and pulmonary vascular resistance index, during OPCAB.

Trial registration

ClinicalTrials.gov (NCT04598191); first submitted 12 October 2020.

Nur mit Berechtigung zugänglich

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Titel: Inhaled iloprost in off-pump coronary artery bypass surgery: a randomized controlled trial
verfasst von: Seo Hee Ko, MD
Jae-Kwang Shim, MD, PhD
Jong-Wook Song, MD, PhD
Sarah Soh, MD, PhD
Young-Lan Kwak, MD, PhD
Publikationsdatum: 26.12.2023
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 4/2024
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02672-3

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Inhaled iloprost in off-pump coronary artery bypass surgery: a randomized controlled trial