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NITRIC OXIDE BENEFIT FOR INFANTS UNDERGOING CONGENITAL HEART SURGERY (p 1464)
October 25, 2000The cardiovascular problems associated with surgery for congenital heart disease in infants may be reduced with the use of postoperative nitric oxide, according to research published in this week's issue of THE LANCET.
Congenital heart disease is present in five to ten per 1000 livebirths. If surgery is required, the most common defects are characterised by raised pulmonary blood flow, pulmonary artery pressure, or both, which result in a high risk of potentially life-threatening postoperative pulmonary hypertensive crises (PHTC). Inhaled nitric oxide is frequently used as rescue therapy. Owen Miller and colleagues from the Royal Alexandra Hospital for Children, Sydney, Australia, did a randomised study to investigate the role of routinely administered inhaled nitric oxide to prevent pulmonary hypertension in infants at high risk.
They enrolled 124 infants (average age 3 months), who had high pulmonary blood flow, pressure, or both, and were undergoing corrective surgery for congenital heart disease. They were randomly assigned continuous low-dose inhaled nitric oxide or placebo from surgery until just before they left the intensive-care unit (ICU). They measured the number of PHTC, time on study gas, and hours spent in intensive care.
Infants receiving inhaled nitric oxide had fewer PHTC than those receiving placebo (four compared with seven), and shorter times until leaving the ICU (80 compared with 112 hours). The time taken to wean infants off study gas was 35% longer in the nitric oxide group than in the placebo group, but was not statistically significant; however, the total time on the study gas was still 30 hours shorter for the nitric oxide group (87 compared with 117 hours).
The investigators conclude that routine use of inhaled nitric oxide after congenital heart surgery can lessen the risk of pulmonary hypertensive crises and shorten the postoperative course, with no toxic effects, in infants at high risk of pulmonary hypertension.
Contact: Professor David S Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; T) +61 2 9515 6519; F) +61 2 9550 6262; E) davidc@card.rpa.cs.nsw.gov.au
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