Optimal Duration of Oral Sildenafil for Perioperative Management of Severe Pulmonary Hypertension in Mitral Valve Replacement

Background: Rheumatic heart disease (RHD) involves the mitral valve in 50–60% of cases. Long-term mitral valve pathologies cause multiple sequelae in the form of atrial fibrillation, pulmonary hypertension, and heart failure. Sildenafil has been used as a therapy for the control of pulmonary hypertension, with emphasis on the perioperative period. Aim: To investigate the influence of oral administration of sildenafil at different durations on intraoperative and postoperative pulmonary hypertension and to compare these effects with preoperative pulmonary pressures. Methods: This comparative cross-sectional study was conducted at Department of Cardiac Surgery, King Edward Medical University/ Mayo Hospital Lahore between July 2024 and January 2025. Patients were divided into 2 groups. Patients enrolled in the short course of sildenafil were administered oral Sildenafil 50mg/5ml, 3 times a day for 2 days before surgery. And in the long course, the same regimen was given for 7 days. Results: A Mann-Whitney U test showed that there was no significant difference in the preoperative mean pulmonary artery pressures between the groups receiving the short and long course of oral sildenafil (p-value 0.890). The reduction in mean pulmonary artery pressures from preoperative to postoperative was analyzed to be 16.46 ± 4.13 for the short course whereas it was 24.83 ± 5.04 for the long course and the difference between these two results was found to be statistically significant (p< 0.05, p< 0.001). Conclusion: Sildenafil has been shown to be effective in the perioperative management of pulmonary hypertension in mitral valve surgery with longer duration of sildenafil administration leading to greater reduction in pressures. Keywords: Rheumatic Heart Disease, Pulmonary Hypertension, Mitral Valve Surgery, Sildenafil, Perioperative Care.