Perioperative sildenafil therapy for children with ventricular septal defects and associated pulmonary hypertension undergoing corrective surgery: A randomised clinical trial

Background and Aims: Sildenafil is known to reduce pulmonary artery pressure but its role in the perioperative period has not been well studied. We aimed to evaluate the efficacy of sildenafil in controlling post-operative pulmonary hypertension in children with pulmonary hypertension undergoing surgeries for correction of ventricular septal defect. Methods: The patients were divided randomly into two groups of thirty each. Group 1 (placebo) received pre-operative placebo and post-operative sildenafil (0.5mg/kg every 6 hrs) while Group 2 (sildenafil) received pre-and post-operative sildenafil (0.5mg/kg every 6 hrs) Results: In the Group 1, systolic pulmonary artery pressure reduced from 81.63 (+/-12.1) mmHg preoperatively to 79.26 (+/- 11.29) mmHg pre-cardiopulmonary bypass (CPB) and 56.76 (+/- 11) mmHg (with 10 minutes post-CPB), whereas in Group 2, it reduced from 83.3 (+/- 12.1) before surgery to 68.9 (+/- 11.3) mmHg pre-CPB and after CPB, to 42.2 (+/- 7.6) mmHg (P = 0.001). The mean pulmonary artery pressure decreased from 60.63 (+/- 10.5) mmHg to 42.13 (+/- 8.3) mmHg in the Group 1 whereas it reduced from 54.36 (+/- 10) mmHg to 31.36 (+/- 6.5) mmHg in Group 2 (P = 0.001). The reductions in pulmonary artery/aortic ratio and Intensive Care Unit stay were statistically significant No adverse effects were recorded. Conclusion: The use of perioperative sildenafil has a statistically significant reduction in the mean pulmonary artery pressure without any adverse effects.