Successful weaning from cardiopulmonary bypass with central venous prostaglandin E-1 and left atrial norepinephrine infusion in patients with acute pulmonary hypertension

Objective: Postoperative pulmonary hypertension increases the mortality ris k in cardiac surgery. We have used central venous prastagtandin E-1 (PGE(1) ) and left atrial norepinephrine (NE) infusion to wean from cardiopulmonary bypass (CPB) patients with refractory postoperative pulmonary hypertension . Design: Observational, nonrandomized study. Setting: Department of Cardiac Surgery in a university hospital. Patients: We studied 10 nonconsecutive American Society of Anesthesiologist s III and New York Heart Association class III-IV patients with postoperati ve pulmonary hypertension and low cardiac output syndrome preventing separa tion from CPB. Interventions: Patients received right atrial PGE(1) (31.5 +/- 6.26 ng/kg/m in) and left atrial NE (0.11 +/- 0.02 mu g/kg/min) infusion. Hemodynamic da ta were obtained before CPB (T0), after CPB under maximal inotropes and vas odilator infusion (T1), 10 mins (T2) and 12 hrs (T3) after PGE(1) and NE in fusion, and 48 hrs after withdrawal of PGE(1) and NE (T4). Measurements and Main Results: All patients were success-fully weaned from CPB and survived, The biatrial infusion of PGE(1) and NE caused a dramatic reduction in mean pulmonary artery pressure (from 42.8 +/- 5.1 mm Hg at T1 to 28.5 +/- 2.6 mm Hg at T2 and 20.5 +/- 2.0 mm Hg at T4), pulmonary vascul ar resistance index (from 1158 +/- 269 dyne.sec/cm(5).m(2) at T1 to 501 +/- 99 dyne sec/cm(5).m(2) at T2 and 246 +/- 50 dyne.sec/cm(5).m(2) at T4), an d pulmonary-to-systemic Vascular resistance index ratio (from 0.61 +/- 0.17 at T1 to 0.20 +/- 0.04 at T2 and 0.11 +/- 0.03 at T4). Cardiac index incre ased from 1.7 +/- 0.2 L/min/m(2) at T1 to 2.3 +/- 0.2 L/min/m(2) at T2 and 2.9 +/- 0.1 L/min/m(2) at T4. Conclusions: In patients with refractory postoperative pulmonary hypertensi on, the combined administration of low-dose PGE(1) in the right atrium and NE in the left atrium is an effective means to wean patients from cardiopul monary bypass.