Perioperative sildenafil therapy in pediatric congenital cardiac disease patients: A meta-analysis

Sildenafil is a pulmonary artery hypertension (PH)-targeted drug that finds an increased indiscriminate use in children with PH secondary to congenital heart disease (CHD). We performed a meta-analysis to evaluate the effects of sildenafil on pediatric patients with PH secondary to CHD during perioperative period. PubMed, EMBASE, the Cochrane Library, and the Google Scholar were searched up to May 2016 for randomized controlled trials (RCTs) assessing the perioperative treatment of sildenafil in pediatric patients with PH secondary to CHD. Major clinical outcomes were mortality before discharge, length of ICU stay, and length of hospitalization. The outcomes were analyzed as continuous and dichotomized variables by using fixed or random effect model, and we computed the pooled RR and MD with 95% confidence interval. Five RCTs involving 238 pediatric patients with PH experienced CHD operation were included. Sildenafil was used in all trials. We observed no differences in mortality before discharge (RR 0.35; 95% CI 0.06-2.10; χ² = 1.31, I² = 0.24, P = 0.25) and length of hospitalization (MD −0.50; 95% CI −1.60 to 0.60; χ² = 5.29, I² = 62%, P = 0.38). There was a decrease in the length of ICU stay (MD −18.18; 95% CI −24.68 to −11.67; χ² = 12.61, I² = 84%, P < 0.00001), which had a high heterogeneity. The findings were robust after the sensitivity analyses. The perioperative treatment of sildenafil for CHD pediatric patients is a potential method to reduce the length of ICU stay. We observed no differences with the use of it in the mortality before discharge and the length of hospitalization.