Original articleCongenital heart surgerySivelestat Attenuates Lung Injury in Surgery for Congenital Heart Disease With Pulmonary Hypertension
Section snippets
Patient and Study Design
This study was a randomized, double-blind, placebo-controlled trial in two parallel treatment groups of neonates or infants, and was approved by the Institutional Review Board of Nagoya City University Hospital. Informed consent was obtained from the parents of each patient. All subjects had congenital heart disease and PH and underwent cardiac surgery using CPB from July 2004 to January 2009.
Eligible patients were neonates or infants with ventricular septal defect (VSD) and pulmonary
Results
The preoperative demographic characteristics and intra- and postoperative clinical data are summarized in Tables 1 and 2, respectively. Pulmonary blood flow was excessive in all patients (mean Qp/Qs, 3.60 ± 1.19; range, 2.30 to 6.20). No patient had high pulmonary vascular resistance (mean Rp/Rs, 0.27 ± 0.07; range, 0.15 to 0.40). No restrictive VSD was confirmed in all patients. The two groups were similar in terms of baseline characteristics. No patient died in either group. Treatment with
Comment
Pulmonary hypertension is a poor prognostic factor in patients undergoing surgery for congenital heart disease, and hence its management is important. The pulmonary vascular condition of patients, operative stress, and the initiation of CPB may increase pulmonary vascular damage after surgery in patients with congenital heart disease and PH. Dilution of blood, contact between blood and the artificial surfaces of the perfusion circuit, and ischemia and reperfusion during CPB activates
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2017, Early Human DevelopmentCitation Excerpt :Studies have reported that sivelestat can prevent changes in neutrophil pliability induced by both inflammatory mediators and dysfunctional pulmonary microcirculation [14,15]. Nomura and colleagues reported in their randomized controlled trial that treatment with sivelestat during bypass surgery prevented pulmonary damage and inhibited proinflammatory cytokine activity [16]. The results from these studies suggested that sivelestat can suppress neutrophil recruitment to lung capillaries and thus prevent the development of ALI.
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