Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery

J. R. Beck, L. B. Mongero, R. M. Kroslowitz, A. F. Choudhri, J. M. Chen, Joseph DeRose, M. Argenziano, A. J. Smerling, M. C. Oz

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decreased blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 ± 2.0 to 26.0 ± 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 ± 3.1 to 75.9 ± 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalPerfusion
Volume14
Issue number1
StatePublished - 1999
Externally publishedYes

Fingerprint

Nitric oxide
Hemodynamics
hypertension
Pulmonary Hypertension
Surgery
surgery
Thoracic Surgery
Nitric Oxide
morbidity
Left ventricular assist devices
Blood pressure
Heart-Assist Devices
mortality
Cardiopulmonary Bypass
Vasodilator Agents
Vascular Resistance
Lung
Pulmonary Artery
Blood
Shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Beck, J. R., Mongero, L. B., Kroslowitz, R. M., Choudhri, A. F., Chen, J. M., DeRose, J., ... Oz, M. C. (1999). Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery. Perfusion, 14(1), 37-42.

Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery. / Beck, J. R.; Mongero, L. B.; Kroslowitz, R. M.; Choudhri, A. F.; Chen, J. M.; DeRose, Joseph; Argenziano, M.; Smerling, A. J.; Oz, M. C.

In: Perfusion, Vol. 14, No. 1, 1999, p. 37-42.

Research output: Contribution to journalArticle

Beck, JR, Mongero, LB, Kroslowitz, RM, Choudhri, AF, Chen, JM, DeRose, J, Argenziano, M, Smerling, AJ & Oz, MC 1999, 'Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery', Perfusion, vol. 14, no. 1, pp. 37-42.
Beck, J. R. ; Mongero, L. B. ; Kroslowitz, R. M. ; Choudhri, A. F. ; Chen, J. M. ; DeRose, Joseph ; Argenziano, M. ; Smerling, A. J. ; Oz, M. C. / Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery. In: Perfusion. 1999 ; Vol. 14, No. 1. pp. 37-42.
@article{7fd4ba5fe2b447878c50ff18f7a3df35,
title = "Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery",
abstract = "Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decreased blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 ± 2.0 to 26.0 ± 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 ± 3.1 to 75.9 ± 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.",
author = "Beck, {J. R.} and Mongero, {L. B.} and Kroslowitz, {R. M.} and Choudhri, {A. F.} and Chen, {J. M.} and Joseph DeRose and M. Argenziano and Smerling, {A. J.} and Oz, {M. C.}",
year = "1999",
language = "English (US)",
volume = "14",
pages = "37--42",
journal = "Perfusion",
issn = "0267-6591",
publisher = "SAGE Publications Ltd",
number = "1",

}

TY - JOUR

T1 - Inhaled nitric oxide improves hemodynamics in patients with acute pulmonary hypertension after high-risk cardiac surgery

AU - Beck, J. R.

AU - Mongero, L. B.

AU - Kroslowitz, R. M.

AU - Choudhri, A. F.

AU - Chen, J. M.

AU - DeRose, Joseph

AU - Argenziano, M.

AU - Smerling, A. J.

AU - Oz, M. C.

PY - 1999

Y1 - 1999

N2 - Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decreased blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 ± 2.0 to 26.0 ± 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 ± 3.1 to 75.9 ± 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.

AB - Severe pulmonary hypertension and right-sided circulatory failure (RSCF) represent an increasing cause of morbidity and mortality in patients undergoing high-risk cardiac surgery. Increased pulmonary vascular resistance in the setting of cardiopulmonary bypass (CPB) may further lead to decreased blood flow across the pulmonary vascular bed; thereby decreasing left ventricular filling and cardiac output. Current management techniques for RSCF include both nonspecific vasodilator and inotropic agents (often limited by systemic hypotension) and the placement of right ventricular assist devices (associated with increased perioperative morbidity). Inhaled nitric oxide (NOi) represents a novel, specific pulmonary vasodilator that has been proven efficacious in these clinical settings. We evaluated 34 patients in 38 operations who underwent cardiac surgery at Columbia Presbyterian Medical Center, and who received NOi (20 ppm) through a modified ventilatory circuit for hemodynamically significant elevations in pulmonary vascular resistance. Nine patients underwent cardiac transplantation, three patients bilateral lung transplantation, 16 patients left ventricular assist device placement and 10 patients routine cardiac surgery. Patients receiving NOi exhibited substantial reductions in mean pulmonary artery pressure (mPAP) (34.6 ± 2.0 to 26.0 ± 1.7 mmHg, p < 0.0001), with improvements in systemic hemodynamics, mean arterial pressure (68 ± 3.1 to 75.9 ± 2.0 mmHg, p = 0.006). In five cases, patients could not be weaned from CPB until NOi was administered. Patients were maintained on NOi from 6 to 240 h postoperatively (median duration 36 h). Inhaled NO induces substantial reductions in mPAP and increases in both cardiac index and systemic blood pressure in patients displaying elevated pulmonary hemodynamics after high-risk cardiac surgery. NO is, therefore, a useful adjunct in these patients in whom acute pulmonary hypertension threatens right ventricular function and hemodynamic stability.

UR - http://www.scopus.com/inward/record.url?scp=0032909610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032909610&partnerID=8YFLogxK

M3 - Article

VL - 14

SP - 37

EP - 42

JO - Perfusion

JF - Perfusion

SN - 0267-6591

IS - 1

ER -