Abstract
Background: Pulmonary hypertension (PH) is a critical complication of cardiac surgery, particularly in patients undergoing pulmonary endarterectomy (PEA), heart transplantation, and lung transplantation. Inhaled iloprost and nitric oxide (NO) are widely used as pulmonary vasodilators; however, their comparative efficacy and safety are unclear.
Objectives: This systematic literature review aimed to compare the effectiveness and safety of inhaled iloprost and NO in managing PH after cardiac surgery, focusing on hemodynamic improvements and adverse effects.
Methods: A systematic search was conducted for randomized controlled trials (RCTs), randomized crossover studies, and open-label trials published until April 2025. Five relevant studies were included, encompassing 115 patients with various forms of post-cardiac surgery-related PH. The primary outcomes included reductions in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). In contrast, the secondary outcomes included hemodynamic parameters, oxygenation, incidence of pulmonary hypertensive crises (PHTC), and adverse events.
Results: Both inhaled iloprost and NO effectively reduced mPAP and PVR across all studies, with no significant differences in the overall efficacy between the two treatments. However, iloprost demonstrated superior effects in improving cardiac output and reducing PVR compared with those of NO. Both therapies were associated with a significant reduction in PHTC and improvement in hemodynamic and oxygenation parameters. Iloprost also exhibited a better safety profile with fewer systemic side effects, such as thrombocytopenia. The studies revealed that the incidence of adverse effects was generally low for both treatments, and no major complications were reported in either group.
Conclusion: Inhaled iloprost provides superior hemodynamic improvements compared with NO, particularly in reducing PVR and increasing cardiac output. Both treatments were safe and effective in managing post-cardiac surgery PH. Iloprost may offer a better alternative to NO, especially for long-term management, given its sustained effects and fewer systemic side effects. Future studies should focus on larger multicenter trials to validate these findings and explore long-term outcomes.
David Marintua Raja Silalahi, Philia Setiawan, Fajar Perdhana, Teuku Husain, Yos Kowara
