Assessment and Study of Inhaled Nitric Oxide Treatment

Hironari No, Kenji Iino, Hideyasu Ueda, Yoji Nishida, Shintaro Takago, Yoshitaka Yamamoto, Yoshiko Shintani, Hiroki Kato, Keiichi Kimura, Hirofumi Takemura

General, Thoracic and Cardiovascular Surgery, Kanazawa University, Kanazawa-shi, Japan

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objectives

Pulmonary hypertension (PH) is often found at the perioperative period of cardiac surgery. It is only recently that inhaled nitric oxide (iNO) therapy was approved at the perioperative in adult case in Japan. We report iNO treatment for PH at the perioperative period of cardiac surgery and summarized the outcomes in our department.

Methods

9 patients (4 men, 5 females, average 68 ± 12 years old) was treated with iNO for PH in the perioperative period of cardiac surgery from April 2016 to June 2017. 2 patients were diagnosed as PH before surgery, and both of which were PH associated with left heart disease. The breakdown of 9 cases was AVR 1 case, MVP 1 case, MVR 3 cases, AVR & MVR & TAP 1 case, AVR & CABG 1 case, on pump CABG 1 case, right ventricular tumor 1 case.

Results

All cases were underwent cardiac surgery with cardiopulmonary bypass. The average iNO time was 39 hours and 45 minutes. The mean pulmonary artery pressure (mPAP) without iNO was 28.9 mmHg, but it improved to 21.0 mmHg with iNO. Cardiac output (CO) was slightly improved to 4.28 L/min from 4.59 L/min. Systolic blood pressure was 107 mmHg without iNO, and it increased to 115 mmHg with iNO. Heart rate (HR) remained to be almost flat at ranged 84.0 to 87.4 bpm. Rebound after iNO treatment was observed in one case, but in other cases, the course of circulatory dynamics was good.

Discussion

iNO treatment was possible to promptly lower mPAP with iNO, increase CO, systolic blood pressure and improve circulatory dynamics. Although rebound was found in one case, iNO treatment for PH after cardiac surgery improves the circulatory dynamics of cardiac surgery perioperative.