Post-op sildenafil in infants after cardiac surgery

Stocker et al¹¹ performed an RCT in 16 ventilated infants early after closure of ventricular or atrioventricular septal defects. They were randomly assigned to one of two groups. Seven infants received iNO (20 ppm) first, with the addition of intravenous sildenafil (0.35 mg/kg over 20 min) after 20 min. Eight infants received sildenafil first, iNO was added after 20 min. Intravenous sildenafil augmented the pulmonary vasodilator effects of iNO in infants early after cardiac surgery. However, sildenafil produced systemic hypotension and impaired oxygenation, which was not improved by iNO. Sildenafil is not recommended for this particular indication.