TITLE:
Pulmonary Hypertension and Cardiac Surgery: Perioperative Management in a Resource Limited Setting
AUTHORS:
Mahamadoun Coulibaly, Mamady Doumbia, Binta Diallo, Salia Ismaila Traore, Aminata Dabo, Siriman Abdoulaye Koita, Abdoulhamidou Almeimoune, Moustapha Issa Mangane, Thierno Madane Diop, Seydina Alioune Beye, Baba Ibrahima Diarra, Modibo Doumbia, Sanoussy Daffé, Mamadou Touré, Souleymane Samate, Brehima Bolimpe Coulibaly, Ousmane Nientao, Mamadou Karim Toure, Youssouf Coulibaly
KEYWORDS:
Cardiac Surgery, Pulmonary Hypertension, Cardiopulmonary Bypass, Sildenafil, Milrinone
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.15 No.11,
November
12,
2025
ABSTRACT: Introduction: Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature. It is defined by a mean pulmonary arterial pressure ≥ 25 mmHg at rest by right heart catheterization. He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass (CPB). Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery. Some specific features in sub-Saharan Africa: given the lack of access to cardiac surgery, PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late. Objective: The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings. Patients and Methods: This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the “Le Luxembourg” Mother and Child University Hospital between January 1, 2023, and June 30, 2024, and who had a preoperative systolic pulmonary artery pressure (SPAP) ≥ 35 mmHg. Preoperatively, all patients included were given Furosemide: 1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults. In the operating room, a nasogastric tube was inserted to administer sildenafil at the end of surgery, and weaning from CPB was performed using Milrinone at a syringe pump rate of 5 μg/kg/min, combined with Norepinephrine as needed depending on hemodynamic status. We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care. Results: During the period, 292 patients underwent surgery, 142 of whom had PH, representing a prevalence of 48.63%. Our patients had an average age of 11.57 ± 11. There was a female predominance of 51.4%. The average length of preoperative hospitalization was 5 days [3 - 8]. The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases. It was ≤1 year in 29.6% of cases. The clinical signs were dominated by dyspnea in 43.7% of cases. Pulmonary artery systolic pressure was between 51 - 100 mmHg in 29.58% and >100 mmHg in 19.72% of cases, with a mean preoperative sPAP of 59 mmHg [35 - 110]. Congenital heart disease accounted for 52.11% of surgical indications, and valvular heart disease for 47.89%. Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%. The mean duration of CPB was 110 min ± 50. There were no intraoperative episodes of pulmonary hypertension. At the end of surgery, the average time to postoperative extubation in intensive care was 3.53 hours ± 2.2. There was a significant decrease in sPAP between the preoperative and postoperative periods. A comparison of pre- and post-operative sPAP averages using a t-test was significant with a P-value Conclusion: PH complicates rheumatic valve disease and certain congenital heart diseases. It is common in our resource-limited setting, where access to cardiac surgery is insufficient. It is associated with high perioperative morbidity and mortality. Management is well codified, but the therapeutic classes are sometimes unavailable in our countries. The postoperative protocol of furosemide + sildenafil and milrinone appears to give good results.