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A systematic review of clinical study evidence for pulmonary vasodilator therapy following surgery with cardiopulmonary bypass in children with CHD.

Publication ,  Journal Article
Foote, HP; Hornik, CP; Hill, KD; Rotta, AT; Kumar, KR; Thompson, EJ
Published in: Cardiol Young
July 20, 2022

OBJECTIVES: Complications from pulmonary hypertension are one of the leading contributors to morbidity and mortality post-cardiopulmonary bypass surgery in children with CHD. Pulmonary vasodilator therapies are commonly used post-operatively, but the optimal target patient population, therapy choice, timing of therapy initiation, and duration of therapy are not well defined. METHODS: We used PubMed and EMBASE to identify studies from 2000 to 2020 investigating the use of pulmonary vasodilator therapy post-cardiopulmonary bypass in children aged 0-18 years. To ensure eligibility criteria, studies were systematically reviewed by two independent reviewers. RESULTS: We identified 26 studies of 42,971 children across four medication classes; 23 were single centre, 14 were prospective, and 11 involved randomisation (four of which employed a placebo-control arm). A disproportionate number of children were from a single retrospective study of 41,872 patients. Definitions varied, but change in pulmonary haemodynamics was the most common primary outcome, used in 14 studies. Six studies had clinical endpoints, with mortality the primary endpoint for two studies. Treatment with inhaled nitric oxide, iloprost, and sildenafil all resulted in improved haemodynamics in specific cohorts of children with post-operative pulmonary hypertension, although improved outcomes were not consistently demonstrated across all treated children. Iloprost may be a cheaper alternative to inhaled nitric oxide with similar haemodynamic response. CONCLUSION: Studies were predominantly single-centre, a control arm was rarely used in randomised studies, and haemodynamic endpoints varied significantly. Further research is needed to reduce post-operative morbidity and mortality from pulmonary hypertension in children with CHD.

Duke Scholars

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

July 20, 2022

Start / End Page

1 / 18

Location

England

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Foote, H. P., Hornik, C. P., Hill, K. D., Rotta, A. T., Kumar, K. R., & Thompson, E. J. (2022). A systematic review of clinical study evidence for pulmonary vasodilator therapy following surgery with cardiopulmonary bypass in children with CHD. Cardiol Young, 1–18. https://doi.org/10.1017/S1047951122002293
Foote, Henry P., Christoph P. Hornik, Kevin D. Hill, Alexandre T. Rotta, Karan R. Kumar, and Elizabeth J. Thompson. “A systematic review of clinical study evidence for pulmonary vasodilator therapy following surgery with cardiopulmonary bypass in children with CHD.Cardiol Young, July 20, 2022, 1–18. https://doi.org/10.1017/S1047951122002293.
Foote, Henry P., et al. “A systematic review of clinical study evidence for pulmonary vasodilator therapy following surgery with cardiopulmonary bypass in children with CHD.Cardiol Young, July 2022, pp. 1–18. Pubmed, doi:10.1017/S1047951122002293.
Journal cover image

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

July 20, 2022

Start / End Page

1 / 18

Location

England

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology