Collins JLG, et al. – The efficacy of postoperative sildenafil was examined for the improvement of clinical outcomes in patients after Fontan operation. Results revealed that routine early administration of sildenafil after Fontan operation was not associated with an improvement in any measured clinical outcome, including postoperative chest tube output (CTO), length of stay (LOS), colloid administration, or duration of mechanical ventilation.

• In this study, the physicians initiated a practice change utilizing intravenous (IV) sildenafil in early postoperative period in all patients undergoing Fontan operation with aim to decrease LOS and CTO.
• 19 patients (February 2014–May 2016) received 0.35 mg/kg sildenafil IV (three doses) followed by enteral, 1 mg/kg every eight hours until hospital discharge.
• Clinical outcomes were compared to 84 pre-protocol controls.
• Vital signs were recorded after second sildenafil dose.
•  Between groups, demographics were similar. 
• Sildenafil group had longer median LOS [9 (7, 11) vs. 13 (8, 25) days, p = 0.016].
• CTO days were longer [6 (5, 8) vs. 8 (6, 13) days, p = 0.011]. 
• Investigations displayed that sildenafil group had longer mechanical ventilation [6.9 (3.5, 11.1) vs. 4 (2, 7) h, p = 0.045] and longer oxygen therapy [99 (52, 225) vs. 14.5 (14, 56) h, p = 0.001].
• There was a trend towards more albumin 5% resuscitation in first 24 h [17 (1, 30) vs. 21 (10, 40) ml/kg, p = 0.069].
•  There was no difference in inotrope score at 24 h, maximum lactate, or fluid balance. 
• Readmission rates were similar.
• No mortality was reported.
• IV sildenafil was well tolerated, and no doses were held.