Clinical Research Inhaled Epoprostenol and Milrinone Effect on Right Ventricular Pressure Waveform Monitoring

Background: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are major complications in cardiac surgery. This study aimed to evaluate the change in RV pressure waveform in patients receiving a combination of inhaled epoprostenol and inhaled milrinone (iE&iM) before cardiopulmonary bypass (CPB) and to assess the safety of this approach with a matched case-control group. Methods: A prospective single-centre cohort study of adult patients undergoing cardiac surgery administered iE&iM through an ultrasonic mesh nebulizer. RV pressure waveform monitoring was obtained by continuously transducing the RV port of the pulmonary artery (PA) catheter.Results: The final analysis included 26 patients receiving iE&iM. There was a significant drop in mean PA pressure (MPAP) (-4.8 +/- 8.7, P = 0.010), systolic PA pressure (SPAP) (-8.2 +/- 12.8, P = 0.003), RV end-diastolic pressure (RVEDP) (-2.1 +/- 2.8, P < 0.001) and RV diastolic pressure gradient (RVDPG) (-1.7 +/- 1.4, P < 0.001) after 17 +/- 9 minutes of iE&iM administration. Patients also had a significant in-