Preoperative Sildenafil administration in children undergoing cardiac surgery: a randomized controlled...

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Pharmacology

Background:

• Sildenafil exhibits cardiac preconditioning properties in animal models.
• Sildenafil has a favorable safety profile in pediatric populations.
• Myocardial ischemia/reperfusion injury is a concern in pediatric cardiac surgery.

Purpose of the Study:

• To evaluate Sildenafil preconditioning for reducing myocardial ischemia/reperfusion injury in children undergoing Ventricular Septal Defect (VSD) closure.
• To assess the impact of Sildenafil on cardiac enzyme release and postoperative outcomes.

Main Methods:

• A randomized, double-blind study involving 39 children (1-17 years) undergoing VSD closure.
• Participants were randomized into three groups: placebo, low-dose Sildenafil (Sild-L), and high-dose Sildenafil (Sild-H).
• Evaluated markers included troponin release, CK-MB, inflammatory markers, bypass/ventilation times, inotropy, and echocardiographic function.

Main Results:

• Aortic cross-clamp time was significantly longer in the high-dose Sildenafil group compared to the control group.
• Creatine kinase-MB (CK-MB) release was significantly higher in the high-dose Sildenafil group.
• No significant differences were observed in inflammatory markers, bypass/ventilation times, inotropy, or echocardiographic function between groups.

Conclusions:

• Sildenafil preconditioning failed to reduce myocardial injury in children undergoing cardiac surgery for VSD closure.
• Sildenafil did not improve cardiac function, inotropic support requirements, or the postoperative course.
• A potential subclinical increase in cardiac enzyme release following Sildenafil preconditioning cannot be ruled out.