Abstract
Introduction: Inhaled pulmonary vasodilators (iPVD) are initiated after CPB during advanced HF operations to reduce RV failure development from high PVR. While inhaled nitric oxide (iNO) is the prototype, its high cost has led to inhaled epoprostenol (iEPO) use. While intravenous epoprostenol contributes to bleeding by platelet inhibition, bleeding and iEPO use has not been compared with iNO in this population. Hypothesis: No differences will be seen in perioperative bleeding between iEPO and iNO groups. Methods: A secondary analysis of a blinded RCT of 232 patients who underwent LVAD placement or orthotopic heart transplantation (HT), to receive either iEPO or iNO (NCT03081052). Bleeding outcomes were classified through POD 7 as blood product units transfused, delayed sternal closure for bleeding, need for re-exploration due to bleeding/tamponade, and chest tube output volume 12-hours immediately after surgery. Three-level ordinal primary outcome for bleeding was determined and compared between groups via univariable and multivariable proportional odds models. A priori bleeding risk factors were used to adjust for a multivariable model. RBC units transfused were compared univariably by negative binomial regression modeling. Results: Of 232 patients, 220 met inclusion criteria: 113 (51%) received iEPO and 107 (49%) received iNO. Of 220, 99 (45%) had LVAD placement while 121 (55%) had HT. Duration of use was similar between groups. Bleeding was common with mild-moderate bleeding in 49 % of the iEPO group v 46 % in iNO group, and severe-massive bleeding in 44% of iEPO group v 47% of iNO group. No differences for bleeding classes were seen in either univariable (OR 1.08, 95% CI: 0.65, 1.81) or multivariable (OR 1.14, 95% CI: 0.60, 2.17) proportional odds models. Modeling showed no differences in RBC transfusion between groups (mean ratio 1.16, 95% CI: 0.82, 1.64). Conclusion: No differences were seen in perioperative bleeding between iEPO v iNO for advanced HF operations.
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