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First experience with sildenafil after Fontan operation: short-term outcomes

Giordano, Raffaele; Palma, Gaetano; Poli, Vincenzo; Palumbo, Sergio; Russolillo, Veronica; Cioffi, Sabato; Mucerino, Marco; Mannacio, Vito Antonio; Vosa, Carlo

Journal of Cardiovascular Medicine: August 2015 - Volume 16 - Issue 8 - p 552–555
doi: 10.2459/JCM.0b013e328361390a
Original articles: Congenital heart disease
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Background We conducted a retrospective study to determine the effect of oral sildenafil administrated as monotherapy after Fontan operation in single ventricle physiology.

Methods From January 2008 to March 2012, during two different periods, a total of 30 pediatric patients undergoing Fontan operation by extracardiac conduit were included in this study. Thirteen patients were in the sildenafil group and exclusively treated with sildenafil given at the dose of 0.35 mg/kg through a nasogastric tube and then orally every 4 h, at the start of cardiopulmonary bypass and for the first postoperative week; then we reduced and discontinued the therapy. The other 17 patients were in the control group. No other vasodilator was administered in both groups. We analyzed intraoperative and postoperative outcomes of sildenafil administration.

Results There were no differences in mortality or operative time. The total and relative drainage loss was lower in the sildenafil group (P = 0.0003 and 0.0045). The hemodynamic parameters showed a better condition in the sildenafil group, with a lower mean pulmonary artery pressure (mPAP) (P = 0.0001) and better mPAP to mean systemic blood pressure (mSBP) ratio (P = 0.0043), whereas there was no difference in peripheral oxygen saturation (P = 0.31). The sidenafil group patients showed other additional positive differences as well as lower inotropic score (P = 0.0005) and intubation time (P = 0.0004). No complications related to the use of sildenafil were noted in any of the children studied.

Conclusion This initial experience provides evidence that sildenafil may be used in postoperative Fontan operation with positive effectiveness.

Department of Clinical Medicine and Cardiovascular Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy

Correspondence to Raffaele Giordano, MD, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Via Pansini 5, Naples 80131, ItalyTel: +39 0 329 709 9540; fax: +39 081 746 2636; e-mail: raf_jordan@inwind.it

Received 20 August, 2012

Revised 8 January, 2013

Accepted 10 March, 2013

© 2015 Italian Federation of Cardiology. All rights reserved.