A comparative study of bosentan versus tadalafil for the management of post-operative pulmonary hypertension in pediatric cardiac surgery patients.

Abstract

BACKGROUND: Our aim is to do comparative study of effect of bosentan and tadalafil in pulmonary hypertension in post operative congenital heart surgery patients and particularly for CPB associated hypertensive crisis. METHODS: 50 pediatric patients between ages of 3 days to 8 years were posted for cardiac surgery was randomly and equally divided into two groups. Group B (n=25) received Tab. bosentan 31.25 or 62.5 mg depending upon the weight of the patient 2 hour before surgery as a premedication along with a sip of water while in Group T (n=25) received Tab tadalafil 1 mg/kg 2 hour before surgery. All the patients were induced with general anesthesia using fentanyl, midazolam and vecuronium followed by maintenance with O2, air, vecuronium +/- propofol if needed. After the surgery, Group B received bosentan 31,25/62.5 mg 12 hourly while Group T received tadalafil 20 mg in a once a day dosage for next 4 days. Patients baseline heart rate, PA pressure, mean right atrial pressure (Mean RAP), cardiac output, cardiac index, pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP- measured by echocardiography), mean arterial pressure (MAP) and systemic vascular resistance (SVR). They were compared in both the groups post operatively minimum for next 4 days. RESULTS: There is significant reduction in Mean PA pressure & PVR after coming off bypass particularly in post operative period in Group B as compared to Group T. There was significant rise in Cardiac output and stroke volume along with improved respiratory parameters including ABG in group B. Heart rate increases significantly in Group T. SVR, MAP and PCWP, LV SV remained unaltered in both the groups. Post operative 2D-echo findings and chest X-ray findings were confirmed in both the groups CONCLUSION: Orally administered dual endothelin-receptor antagonist bosentan significantly reduces PVR and PA Pressure in pediatric patients after cardiac surgery. Our study concludes that bosentan is the preferred choice of treatment in management of postoperative pulmonary hypertension in cardiac surgery.