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Ann Thorac Surg 2003;76:711-718
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy

Thorsten Kramm, MDa*, Balthasar Eberle, MDb, Frank Krummenauer, PhDc, Stefan Guth, MDa, Hellmut Oelert, MDa, Eckhard Mayer, MDa

a Departments of Cardiothoracic and Vascular Surgery, Mainz, Germany
b and Anesthesiology, Mainz, Germany
c Institute For Medical Statistics, Johannes Gutenberg-University Medical School, Mainz, Germany

Accepted for publication April 18, 2003.

* Address reprint requests to Dr Kramm, Department for Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Medical School, Langenbeckstrasse 1, D-55131 Mainz, Germany.
e-mail: kramm{at}mail.uni-mainz.de

BACKGROUND: In primary pulmonary hypertension, aerosolized prostanoids selectively reduce pulmonary vascular resistance and improve right ventricular function. In this study, hemodynamic effects of inhaled iloprost, a stable prostacyclin analogue, were evaluated in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and early after pulmonary thromboendarterctomy (PTE).

METHODS: Ten patients (mean age 49 years old [32 to 70 years old], New York Heart Association functional class III and IV) received a dose of 33 µg aerosolized iloprost immediately before surgery (T1), after intensive care unit admission (T2), and 12-hours postoperatively (T3). Effects on pulmonary and systemic hemodynamics and gas exchange were recorded and compared with preinhalation baseline values.

RESULTS: Preoperatively, inhaled iloprost did not significantly change mean pulmonary artery pressure (mPAP), cardiac index (CI), or pulmonary vascular resistance (PVR). Postoperatively, inhaled iloprost induced a significant reduction of mPAP and PVR and a significant increase of CI at T2 and T3. Preinhalation versus postinhalation PVR was as follows: at T1, 847 versus 729 dynes · s · cm-5, p = 0.45; at T2, 502 versus 316 dynes · s · cm-5, p = 0.008; and at T3, 299 versus 227 dynes · s · cm-5, p = 0.004.

CONCLUSIONS: In patients with CTEPH, inhalation of iloprost elicits no significant pulmonary vasodilation before surgery, and may have detrimental effects on systemic hemodynamics. Postoperatively, it significantly reduces mPAP and PVR, and enhances CI. Following PTE, inhalation of iloprost is useful to improve early postoperative hemodynamics.




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