Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 6, December 2019, pages 369-377

Pre-Operative Sildenafil for Patients With Pulmonary Hypertension Undergoing Mitral Valve Surgery: A Systematic Review and Meta-Analysis

Figures

Figure 1.
Figure 1. PRISMA flow diagram of study screening and selection. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2. Cochrane risk of bias assessment tool (a), and Cochrane risk of bias assessment summary (b).
Figure 3.
Figure 3. Forest plot showing the mean difference between pre- and intra-operative sPAP in the sildenafil and placebo groups. sPAP: systolic pulmonary artery pressure.
Figure 4.
Figure 4. Forest plot showing the mean difference between pre- and post-operative sPAP in the sildenafil and placebo groups. sPAP: systolic pulmonary artery pressure.
Figure 5.
Figure 5. Forest plot showing the mean difference between pre- and intra-operative mPAP in the sildenafil and placebo groups. mPAP: mean pulmonary artery pressure.
Figure 6.
Figure 6. Forest plot showing the mean difference between pre- and intra-operative PVR in the sildenafil and placebo groups. PVR: pulmonary vascular resistance.
Figure 7.
Figure 7. Forest plot showing the mean difference between pre- and intra-operative SVR in the sildenafil and placebo groups. SVR: operative systemic vascular resistance.
Figure 8.
Figure 8. Forest plot showing the mean difference between pre- and intra-operative MAP in the sildenafil and placebo groups. MAP: mean arterial pressure.
Figure 9.
Figure 9. Forest plot showing the pooled risk ratio of pre-operative sildenafil and post-operative inotrope requirement.

Table

Table 1. Summary of Included Studies
 
Study title, study design, author, and year of publicationPopulation and study designInterventionHemodynamic parameters measuredOther outcomes reported
sPAP: systolic pulmonary artery pressure; CVP: central venous pressure; RVSP: right ventricular systolic pressure; mPAP: mean pulmonary artery pressure; PVR: pulmonary vascular resistance; SVR: systemic vascular resistance.
Effect of immediate pre-operative oral sildenafil administration for pulmonary hypertension in patients undergoing mitral valve replacement (Ayyad et al, 2012) [21]Sixty adult patients with mean sPAP 75.3 mm Hg scheduled for elective mitral valve replacement, double-blind randomized controlled trialGroup A: sildenafil 25 - 50 mg (according to weight) given 60 min before induction of anesthesia; group B: placeboSystemic blood pressure; pre-operative echocardiography; sPAP: pre-, intra-, and post-operative; CVP: pre-, intra-, and post-operativeNone
Effect of pre-operative oral sildenafil on severe pulmonary arterial hypertension in patients undergoing mitral valve replacement (Gandhi et al, 2014) [22]Forty adult patients with RVSP ≥ 50 mm Hg scheduled for elective mitral valve replacement, double-blind randomized controlled trialGroup A: sildenafil 25 mg given three times a day for 24 h before the surgery; group B: placeboMean arterial pressure, pre-operative echocardiography; sPAP, mPAP, SVR and PVR: pre-, intra-, and post-operativeBypass time, cross-clamp time, inotrope requirement post-operative, ventilation time, post-operative recovery stay, mortality
Effect of oral sildenafil citrate on intra-operative hemodynamics in patients with pulmonary hypertension undergoing valvular heart surgery (Shim et al, 2006) [20]Fifty-three adult patients with mPAP ≥ 30 mm Hg scheduled for elective valve replacement, double-blind randomized controlled trialGroup A: sildenafil 50 mg given 10 min prior to the surgery; group B: placeboMean arterial pressure: pre-operative echocardiography, sPAP, mPAP, SVR and PVR: pre-, intra-, and post-operativeInotrope requirement post-operative, mortality