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Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery
Kamrouz Ghadimi1, Jhaymie L Cappiello2, Mary Cooter Wright1
1Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, and the Clinical Research Unit (K.G., M.C.W., J.H.L.), Duke University School of Medicine, Durham, NC.
Inhaled epoprostenol (iEPO) is as effective as inhaled nitric oxide (iNO) in preventing right ventricular failure (RVF) after complex cardiac surgery. This finding supports iEPO as a cost-effective alternative for managing postoperative RVF in advanced heart failure patients.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Right ventricular failure (RVF) is a significant cause of mortality following major cardiac surgery for advanced heart failure.
- Inhaled pulmonary-selective vasodilators, including inhaled epoprostenol (iEPO) and nitric oxide (iNO), are crucial for managing postoperative RVF.
- Clinical trial evidence guiding the selection between iEPO and iNO is limited, despite cost differences.
Purpose of the Study:
- To compare the efficacy and safety of inhaled epoprostenol (iEPO) versus inhaled nitric oxide (iNO) in preventing right ventricular failure (RVF) after major cardiac surgery for advanced heart failure.
- To assess secondary postoperative outcomes in patients receiving either iEPO or iNO.
Main Methods:
- A double-blind, randomized trial involving 231 participants undergoing orthotopic heart transplantation or left ventricular assist device implantation.
- Participants received either continuous iEPO or iNO from separation from cardiopulmonary bypass through the intensive care unit stay.
- The primary outcome was the composite RVF rate, with secondary outcomes including mechanical ventilation duration, length of stay, acute kidney injury, and mortality.
Main Results:
- The composite RVF rate was 25.0% in the iEPO group and 22.5% in the iNO group, demonstrating equivalence (risk difference 2.5%, 90% CI -6.6% to 11.6%).
- No significant differences were observed between the iEPO and iNO groups for any of the secondary postoperative outcomes.
- The study met its primary endpoint, supporting the equivalence of iEPO and iNO for RVF prevention.
Conclusions:
- Inhaled epoprostenol (iEPO) is associated with similar risks of RVF development and other postoperative complications compared to inhaled nitric oxide (iNO) in patients undergoing major cardiac surgery for advanced heart failure.
- iEPO represents a viable therapeutic option for managing postoperative RVF, potentially offering a cost-effective alternative to iNO.
- Further research may explore long-term outcomes and cost-effectiveness in different clinical settings.
