Inhaled nitric oxide versus sodium nitroprusside for preoperative evaluation of pulmonary hypertension in heart transplant candidates.
Pasero D, Rana NK, et al.Transplantation Proceedings 45(7): 2746-2749
Aims
To evaluate the safety and feasibility of inhaled nitric oxide compared with sodium nitroprusside to test pulmonary vascular resistance (PVR) reversibility, while avoiding systemic hypotension.
Interventions
In this crossover study patients were randomly assigned to receive either inhaled nitric oxide or intravenous sodium nitroprusside.
Participants
9 patients affected by end stage heart failure undergoing evaluation for heart transplantation.
Outcomes
The outcomes included systolic, diastolic, and mean arterial pressure, heart rate systolic, diastolic and mean pulmonary pressure, pulmonary capillary wedge pressure and cardiac index.
Follow-up
Not specified.
CET Conclusions
This randomised-crossover study investigates the use of inhaled nitric oxide as an alternative to sodium nitroprusside in assessing the reversibility of pulmonary vascular resistance in patients with pulmonary hypertension awaiting cardiac transplantation. The authors demonstrate that nitric oxide does significantly reduce pulmonary vascular resistance and suggest that it may have less effect on systemic blood pressure than sodium nitroprusside. The numbers here are small (9 patients, all male) due to difficulty recruiting. Further evidence in a larger number of patients is required, but the results are nonetheless interesting as they may represent a safer method of assessing the reversibility of pulmonary hypertension in this high-risk group of patients.
Data analysis
Per protocol analysis
Trial registration
Not reported.