Routine Sildenafil Does Not Improve Clinical Outcomes After Fontan Operation

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Pharmacology

Background:

• Fontan operation can lead to persistent chest tube output (CTO), increasing hospital length of stay (LOS).
• Postoperative sildenafil has shown promise in improving outcomes for select Fontan patients.

Purpose of the Study:

• To evaluate the impact of early postoperative intravenous (IV) sildenafil on reducing LOS and CTO in patients undergoing Fontan operation.
• To assess the safety and efficacy of a standardized sildenafil protocol in the early postoperative period.

Main Methods:

• A practice change involved administering IV sildenafil to 19 patients post-Fontan operation (Feb 2014-May 2016).
• The protocol included IV sildenafil followed by enteral administration until discharge.
• Outcomes were compared to 84 pre-protocol control patients.

Main Results:

• The sildenafil group experienced longer median LOS (13 vs. 9 days) and CTO days (8 vs. 6 days).
• Mechanical ventilation (6.9 vs. 4 h) and oxygen therapy (99 vs. 14.5 h) durations were significantly longer in the sildenafil group.
• No significant differences were observed in inotrope score, maximum lactate, fluid balance, or readmission rates. No mortality occurred.

Conclusions:

• Routine early administration of IV sildenafil after Fontan operation did not improve clinical outcomes.
• The practice change was not associated with a decrease in postoperative CTO, LOS, colloid administration, or mechanical ventilation duration.
• Sildenafil was well tolerated with no doses withheld, but did not confer the intended clinical benefits.