1
|
Saxena R, Agrawal T, Saxen R, Pathak M, Nayak S, Jadhav AS, Rathod KJ, Sinha A. Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. Pediatr Surg Int 2024; 40:156. [PMID: 38871828 DOI: 10.1007/s00383-024-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. METHODOLOGY This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. RESULTS There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). CONCLUSION In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.
Collapse
Affiliation(s)
- Rahul Saxena
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India.
| | - Tripti Agrawal
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Rahul Saxen
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Shubhalaxmi Nayak
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Avinash Sukdev Jadhav
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Kirtikumar J Rathod
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| | - Arvind Sinha
- Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, 342001, Rajasthan, India
| |
Collapse
|
2
|
Chauhan D, Mehaffey JH, Hayanga JWA, Udassi JP, Badhwar V, Mascio CE. Volume Alone Does Not Predict Quality Outcomes in Hospitals Performing Pediatric Cardiac Surgery. Ann Thorac Surg 2024; 117:1187-1193. [PMID: 38290594 DOI: 10.1016/j.athoracsur.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Lower institutional volume has been associated with inferior pediatric cardiac surgery outcomes. This study explored the variation in mortality rates among low-, mid-, and high-volume hospitals performing pediatric cardiac surgery in the United States. METHODS The Kids' Inpatient Database was explored for the years 2016 and 2019. Hospitals performing only off-bypass coarctation and ventricular septal defect repair were omitted. The hospitals were divided into 3 groups by their annual case volume. Multivariable logistic regression models were fit to obtain risk-adjusted in-hospital mortality rates. RESULTS A total of 25,749 operations performed by 235 hospitals were included in the study. The risk-adjusted mortality rate for the entire sample was 1.9%. There were 140 hospitals in the low-volume group, 64 hospitals in the mid-volume group, and 31 in the high-volume group. All groups had low-mortality (mortality <1.9%) and high-mortality (mortality >1.9%) hospitals. Among low-volume hospitals, 53% were low-mortality (n = 74) and 47% were high-mortality (n = 66) hospitals. Among mid-volume hospitals, 58% were low-mortality (n = 37) and 42% were high-mortality (n = 27) hospitals. Among high-volume hospitals, 68% were low-mortality (n = 21) and 32% were high-mortality (n = 10) hospitals. There was no statistically significant difference in risk-adjusted in-hospital mortality when comparing low-, mid-, and high-volume centers for 7 Society of Thoracic Surgeons benchmark procedures. CONCLUSIONS This national, real-world, risk-adjusted volume outcome analysis highlights that volume alone may not be the sole arbiter to predict quality of pediatric cardiac surgery outcomes. Using case volume alone as a surrogate for quality may unfairly asperse high-performing, low-volume programs.
Collapse
Affiliation(s)
- Dhaval Chauhan
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Jai P Udassi
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University, Morgantown, West Virginia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Christopher E Mascio
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
| |
Collapse
|
3
|
Greene JJ, Chao S, Tsui BCH. Clinical Outcomes of Erector Spinae Plane Block for Midline Sternotomy in Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2024; 38:964-973. [PMID: 38341301 DOI: 10.1053/j.jvca.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To evaluate the benefit of single-shot erector spinae plane block (ESPB) on pain at postoperative hours 4 and 12, duration of mechanical ventilation, hospital length of stay, intensive care unit (ICU) length of stay, cumulative postoperative opioid usage, and incidence of postoperative nausea and vomiting (PONV) after cardiac surgery via sternotomy DESIGN: A systematic review and meta-analysis of randomized controlled trials and prospective clinical trials. SETTING Studies were identified through the search of PubMed and EMBASE on July 19, 2023. PARTICIPANTS Adults and children undergoing cardiac surgery via sternotomy. INTERVENTIONS Single-shot ESPB versus standard-of-care analgesia. MEASUREMENTS AND MAIN RESULTS A systematic review and meta-analysis of 10 studies (N = 695 patients). The single-shot ESPB arm exhibited statistically significant reductions in pain score at postoperative hour 4 (standardized mean difference [SMD] -2.95, 95% CI -5.86 to -0.04, p = 0.0466), duration of mechanical ventilation (SMD -1.23, 95% CI -2.21 to -0.24, p = 0.0145), cumulative postoperative opioid usage (SMD -1.48, 95% CI -2.46 to -0.49, p = 0.0033), and PONV incidence (risk ratio 0.4358, 95% CI 0.2105-0.9021, p = 0.0252). The single-shot ESPB arm did not exhibit a statistically significant reduction in pain score at postoperative hour 12, length of hospital stay, and length of ICU stay. CONCLUSIONS Single-shot ESPB improves near-term clinical outcomes in patients undergoing cardiac surgery via sternotomy. More randomized controlled trials are needed to validate these findings.
Collapse
Affiliation(s)
- Jacob J Greene
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; University of California - San Francisco School of Medicine, University of California - San Francisco, San Francisco, CA
| | - Sharon Chao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
4
|
Wang Q, Liu H, Zou L, Cun Y, Shu Y, Patel N, Yu D, Mo X. Early predictors of bacterial pneumonia infection in children with congenital heart disease after cardiopulmonary bypass: a single-centre retrospective study. BMJ Open 2024; 14:e076483. [PMID: 38485478 PMCID: PMC10941142 DOI: 10.1136/bmjopen-2023-076483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the early predictors of bacterial pneumonia infection in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB). DESIGN Retrospective study. SETTING A freestanding tertiary paediatric hospital in China. PARTICIPANTS Patients admitted to the hospital due to CHD who underwent open-heart surgery. OUTCOME MEASURES We retrospectively reviewed and analysed data from 1622 patients with CHD after CPB from June 2018 to December 2020 at the Children's Hospital of Nanjing Medical University. Enrolled patients were assigned to an infection group or a non-infection group according to the presence of postoperative bacterial pneumonia infection, and the differences in clinical indicators were compared. Potential predictors were analysed by multivariate logistic regression analysis and area under the curve (AUC) analysis. RESULTS Among the 376 patients (23.2%) in the infection group, the three most common bacteria were Streptococcus pneumoniae in 67 patients (17.8%), Escherichia coli in 63 patients (16.8%) and Haemophilus influenzae in 53 patients (14.1%). The infection group exhibited a lower weight (8.0 (6.0-11.5) kg vs 11.0 (7.5-14.5) kg, p<0.001). In the infection group, procalcitonin (PCT) (ng/mL: 4.72 (1.38-9.52) vs 1.28 (0.47-3.74), p<0.001) and C reactive protein (CRP) (mg/L: 21.0 (12.1-32.0) vs 17.0 (10.0-27.0), p<0.001) levels were significantly greater than those in the non-infection group. Binary logistic regression analysis revealed that weight, PCT and CRP were independent risk factors for pulmonary bacterial infection after CPB. The AUCs of weight, PCT, CRP and PCT+CRP for predicting pulmonary bacterial infection after CPB were 0.632 (95% CI 0.600 to 0.664), 0.697 (95% CI 0.667 to 0.727), 0.586 (95% CI 0.554 to 0.618) and 0.694 (95% CI 0.664 to 0.724), respectively, and the cut-off values were ≤10.25 kg, ≥4.25 ng/mL, ≥6.50 mg/L and ≥0.20, respectively. The sensitivities were 69.7%, 54.0%, 93.9% and 70.2%, and the specificities were 53.5%, 77.7%, 19.4% and 59.1%, respectively. CONCLUSIONS In our study, weight, PCT and CRP were found to be independent predictors of pulmonary bacterial infection after CPB. Moreover, PCT was the most specific predictor, and CRP was the most sensitive independent predictor that might be beneficial for the early diagnosis of pulmonary bacterial infection after CPB in patients with CHD.
Collapse
Affiliation(s)
- Qingfeng Wang
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Liu
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liang Zou
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yueshuang Cun
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaqin Shu
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Nishant Patel
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Di Yu
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuming Mo
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
5
|
Li H, Zhou M, Sun Y, Yang J, Zeng X, Qiu Y, Xia Y, Zheng Z, Yu J, Feng Y, Shi Z, Huang T, Tan L, Lin R, Li J, Fan X, Ye J, Duan H, Shi S, Shu Q. A Patient Similarity Network (CHDmap) to Predict Outcomes After Congenital Heart Surgery: Development and Validation Study. JMIR Med Inform 2024; 12:e49138. [PMID: 38297829 PMCID: PMC10850852 DOI: 10.2196/49138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/21/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
Background Although evidence-based medicine proposes personalized care that considers the best evidence, it still fails to address personal treatment in many real clinical scenarios where the complexity of the situation makes none of the available evidence applicable. "Medicine-based evidence" (MBE), in which big data and machine learning techniques are embraced to derive treatment responses from appropriately matched patients in real-world clinical practice, was proposed. However, many challenges remain in translating this conceptual framework into practice. Objective This study aimed to technically translate the MBE conceptual framework into practice and evaluate its performance in providing general decision support services for outcomes after congenital heart disease (CHD) surgery. Methods Data from 4774 CHD surgeries were collected. A total of 66 indicators and all diagnoses were extracted from each echocardiographic report using natural language processing technology. Combined with some basic clinical and surgical information, the distances between each patient were measured by a series of calculation formulas. Inspired by structure-mapping theory, the fusion of distances between different dimensions can be modulated by clinical experts. In addition to supporting direct analogical reasoning, a machine learning model can be constructed based on similar patients to provide personalized prediction. A user-operable patient similarity network (PSN) of CHD called CHDmap was proposed and developed to provide general decision support services based on the MBE approach. Results Using 256 CHD cases, CHDmap was evaluated on 2 different types of postoperative prognostic prediction tasks: a binary classification task to predict postoperative complications and a multiple classification task to predict mechanical ventilation duration. A simple poll of the k-most similar patients provided by the PSN can achieve better prediction results than the average performance of 3 clinicians. Constructing logistic regression models for prediction using similar patients obtained from the PSN can further improve the performance of the 2 tasks (best area under the receiver operating characteristic curve=0.810 and 0.926, respectively). With the support of CHDmap, clinicians substantially improved their predictive capabilities. Conclusions Without individual optimization, CHDmap demonstrates competitive performance compared to clinical experts. In addition, CHDmap has the advantage of enabling clinicians to use their superior cognitive abilities in conjunction with it to make decisions that are sometimes even superior to those made using artificial intelligence models. The MBE approach can be embraced in clinical practice, and its full potential can be realized.
Collapse
Affiliation(s)
- Haomin Li
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mengying Zhou
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yuhan Sun
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xian Zeng
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yunxiang Qiu
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuanyuan Xia
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhijie Zheng
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jin Yu
- Ultrasonography Department, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuqing Feng
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhuo Shi
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ting Huang
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Linhua Tan
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ru Lin
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Li
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiangming Fan
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Ye
- Ultrasonography Department, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Shanshan Shi
- Cardiac Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiang Shu
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
6
|
Zürn C, Hübner D, Ziesenitz VC, Höhn R, Schuler L, Schlange T, Gorenflo M, Kari FA, Kroll J, Loukanov T, Klemm R, Stiller B. Model-driven survival prediction after congenital heart surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad089. [PMID: 37279735 PMCID: PMC10493173 DOI: 10.1093/icvts/ivad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The objective of the study was to improve postoperative risk assessment in congenital heart surgery by developing a machine-learning model based on readily available peri- and postoperative parameters. METHODS Our bicentric retrospective data analysis from January 2014 to December 2019 of established risk parameters for dismal outcome was used to train and test a model to predict postoperative survival within the first 30 days. The Freiburg training data consisted of 780 procedures; the Heidelberg test data comprised 985 procedures. STAT mortality score, age, aortic cross-clamp time and postoperative lactate values over 24 h were considered. RESULTS Our model showed an area under the curve (AUC) of 94.86%, specificity of 89.48% and sensitivity of 85.00%, resulting in 3 false negatives and 99 false positives.The STAT mortality score and the aortic cross-clamp time each showed a statistically highly significant impact on postoperative mortality. Interestingly, a child's age was barely statistically significant. Postoperative lactate values indicated an increased mortality risk if they were either constantly at a high level or low during the first 8 h postoperatively with an increase afterwards.When considering parameters available before, at the end of and 24 h after surgery, the predictive power of the complete model achieved the highest AUC. This, compared to the already high predictive power alone (AUC 88.9%) of the STAT mortality score, translates to an error reduction of 53.5%. CONCLUSIONS Our model predicts postoperative survival after congenital heart surgery with great accuracy. Compared with preoperative risk assessments, our postoperative risk assessment reduces prediction error by half. Heightened awareness of high-risk patients should improve preventive measures and thus patient safety.
Collapse
Affiliation(s)
- Christoph Zürn
- Department of Congenital Heart Defects and Paediatric Cardiology, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - David Hübner
- Machine learning for medical applications, Averbis GmbH, Freiburg, Germany
| | - Victoria C Ziesenitz
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center—University of Heidelberg, Faculty of Medicine, University of Heidelberg, Germany
| | - René Höhn
- Department of Congenital Heart Defects and Paediatric Cardiology, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Lena Schuler
- Department of Congenital Heart Defects and Paediatric Cardiology, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tim Schlange
- Faculty of Psychology, Ruhr University, Bochum, Germany
| | - Matthias Gorenflo
- Department of Paediatric Cardiology and Congenital Heart Disease Center for Child and Adolescent Health, Medical Center—University of Heidelberg, Faculty of Medicine, University of Heidelberg, Germany
| | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Tsvetomir Loukanov
- Department of Cardiothoracic Surgery, Medical Center—University of Heidelberg, Faculty of Medicine, University of Heidelberg, Germany
| | - Rolf Klemm
- Department of Cardiovascular Surgery, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Paediatric Cardiology, University Heart Center Freiburg—Bad Krozingen, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
7
|
Cheng M, Xu HZ, Zhang KJ, Peng XL, Pan ZX, Hu Y. Risk Factors of Perioperative Brain Injury in Children Under Two Years Undergoing Coarctation Repair. Pediatr Neurol 2023; 141:109-117. [PMID: 36812697 DOI: 10.1016/j.pediatrneurol.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND To investigate clinical manifestations and factors of perioperative brain injury (PBI) after surgical repair of coarctation of the aorta (CoA) combined with other heart malformations under cardiopulmonary bypass (CPB) in children under two years. METHODS The clinical data of 100 children undergoing CoA repair were retrospectively reviewed between January 2010 and September 2021. Univariate and multivariate analyses were performed to identify factors of PBI development. Hierarchical and K-means cluster analyses were conducted to evaluate the association between hemodynamic instability and PBI. RESULTS Eight children developed postoperative complications, and all of them had a favorable neurological outcome one year after surgery. Univariate analysis revealed eight risk factors associated with PBI. Multivariate analysis indicated operation duration (P = 0.04, odds ratio [OR], 2.93; 95% confidence interval [CI], 1.04 to 8.28) and pulse pressure (PP) minimum (P = 0.01; OR, 0.22; 95% CI, 0.06 to 0.76) were independently associated with PBI. The following three parameters emerged for cluster analysis: PP minimum, mean arterial pressure (MAP) dispersion, and systemic vascular resistance (SVR) average. Using cluster analysis, PBI mainly occurred in subgroups 1 (12%, three of 26) and 2 (10%, five of 48). The mean value of PP and MAP in subgroup 1 was significantly higher than in subgroup 2. The mean SVR in subgroup 1 was the highest. The lowest PP minimum, MAP, and SVR were observed in subgroup 2. CONCLUSION Lower PP minimum and longer operation duration were independent risk factors for developing PBI in children under two years during CoA repair. Unstable hemodynamics should be avoided during CPB.
Collapse
Affiliation(s)
- Min Cheng
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong-Zhen Xu
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China; Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Kai-Jun Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China; Department of Cardiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Ling Peng
- Division of Science and Technology, Beijing Normal University-HongKong Baptist University United International College, Guangdong, China
| | - Zheng-Xia Pan
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China; Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
| |
Collapse
|
8
|
Chakraborty A, Ramakrishnan K, Buyukgoz C, Tadphale S, Allen J, Absi M, Briceno-Medina M, Boston U, Knott-Craig CJ. Incidence of Acute Neurological Events in Neonates and Infants Undergoing Cardiac Surgery Using a High-Hematocrit/ High-Flow Bypass Strategy. World J Pediatr Congenit Heart Surg 2023; 14:375-379. [PMID: 36872647 DOI: 10.1177/21501351221143950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: The incidence of new acute neurological injury occurring in neonates and infants during cardiac surgery utilizing cardiopulmonary bypass is reportedly 3% to 5%. In 2013, we adopted a high flow rate, and high hematocrit bypass strategy, and sought to assess the incidence of early neurological injuries associated with this strategy. Methods: Neonates and infants undergoing cardiopulmonary bypass between January 2013 and December 2019 (n = 714) comprise the study. Adverse neurological events (ANEs) were defined as any abnormality of pupils, delayed awakening, seizures, focal neurological deficits, concerns prompting neurological consultation, or any abnormality on neurological imaging in the postoperative period. Our bypass strategy included a high flow rate (150-200 mL/kg/min), without reduction of flow rates during cooling and maintaining a target hematocrit on bypass > 32% with a terminal hematocrit of > 42%. Results: Median weight at the time of the procedure was 4.6 kg (IQR 3.6-6.1 kg) with the smallest patient weighing 1.36 kg. There were 46 premature patients (6.4%). There were 149 patients (20.9%) patients who underwent deep hypothermic circulatory arrest with a median time of 26 min (IQR 21-41 min). Hospital mortality was 3.5% (24/714, 95% CI: 2.28-5.13). The incidence of neurological events as defined above was 0.84% (6/714, 95% CI: 0.31-1.82). Neurological imaging identified ischemic injury in 4 patients and intraventricular hemorrhage in 2. Conclusions: High flow/high hematocrit bypass strategy was associated with a low incidence of ANE in this vulnerable population.
Collapse
Affiliation(s)
- Abhishek Chakraborty
- Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Karthik Ramakrishnan
- Pediatric Cardiovascular Surgery, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Cihangir Buyukgoz
- Pediatric Critical Care Medicine, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Sachin Tadphale
- Pediatric Critical Care Medicine, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Jerry Allen
- Pediatric Cardiovascular Surgery, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Mohammed Absi
- Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Maria Briceno-Medina
- Pediatric Cardiology, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Umar Boston
- Pediatric Cardiovascular Surgery, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christopher J Knott-Craig
- Pediatric Cardiovascular Surgery, University of Tennessee, Le Bonheur Children's Hospital, Memphis, TN, USA
| |
Collapse
|
9
|
Left Atrioventricular Transvalvular Pressure Gradients Derived from Intraoperative and Postoperative Echocardiograms following Atrioventricular Septal Defect Repair. Diagnostics (Basel) 2023; 13:diagnostics13050957. [PMID: 36900100 PMCID: PMC10001237 DOI: 10.3390/diagnostics13050957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Left atrioventricular valve (LAVV) stenosis following an atrioventricular septal defect (AVSD) repair is a rare but potentially life-threatening complication. While echocardiographic quantification of diastolic transvalvular pressure gradients is paramount in the evaluation of a newly corrected valve function, it is hypothesized that these measured gradients are overestimated immediately following a cardiopulmonary bypass (CPB) due to the altered hemodynamics when compared to postoperative valve assessments using awake transthoracic echocardiography (TTE) upon recovery after surgery. METHODS Out of the 72 patients screened for inclusion at a tertiary center, 39 patients undergoing an AVSD repair with both intraoperative transesophageal echocardiograms (TEE, performed immediately after a CPB) and an awake TTE (performed prior to hospital discharge) were retrospectively selected. The mean (MPGs) and peak pressure gradients (PPGs) were quantified using a Doppler echocardiography and other measures of interest were recorded (e.g., a non-invasive surrogate of the cardiac output and index (CI), left ventricular ejection fraction, blood pressures and airway pressures). The variables were analyzed using the paired Student's t-tests and Spearman's correlation coefficients. RESULTS The MPGs were significantly higher in the intraoperative measurements when compared to the awake TTE (3.0 ± 1.2 vs. 2.3 ± 1.1 mmHg; p < 0.01); however, the PPGs did not significantly differ (6.6 ± 2.7 vs. 5.7 ± 2.8 mmHg; p = 0.06). Although the assessed intraoperative heart rates (HRs) were also higher (132 ± 17 vs. 114 ± 21 bpm; p < 0.001), there was no correlation found between the MPG and the HR, or any other parameter of interest, at either time-point. In a further analysis, a moderate to strong correlation was observed in the linear relationship between the CI and the MPG (r = 0.60; p < 0.001). During the in-hospital follow-up period, no patients died or required an intervention due to LAVV stenosis. CONCLUSIONS The Doppler-based quantification of diastolic transvalvular LAVV mean pressure gradients using intraoperative transesophageal echocardiography seems to be prone to overestimation due to altered hemodynamics immediately after an AVSD repair. Thus, the current hemodynamic state should be taken into consideration during the intraoperative interpretation of these gradients.
Collapse
|
10
|
Cruz-Suárez GA, Rebellón Sánchez DE, Torres-Salazar D, Arango Sakamoto A, López-Erazo LJ, Quintero-Cifuentes IF, Vélez-Esquivia MA, Jaramillo-Valencia SA, Suguimoto-Erasso AJT. Postoperative Outcomes of Analgesic Management with Erector Spine Plane Block at T5 Level in Pediatric Patients Undergoing Cardiac Surgery with Sternotomy: A Cohort Study. Local Reg Anesth 2023; 16:1-9. [PMID: 36798075 PMCID: PMC9926978 DOI: 10.2147/lra.s392307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery. Methods A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022. Results Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4-11)) compared to the CA group (median 10.5 days (IQR: 6-25)). Likewise, there was a higher probability of discharge from the ICU in the ESPB group (HR 1.71 (95% CI: 1.05-2.79)). The ESPB group had lower opioid consumption (p < 0.05). There were no differences in time to extubation, mortality, and postoperative complications. Conclusion ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery is feasible and associated with shorter hospital length of stay, faster ICU discharge and lower opioid consumption.
Collapse
Affiliation(s)
- Gustavo A Cruz-Suárez
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia,Correspondence: Gustavo A Cruz-Suárez, Fundación Valle del Lili, Anesthesiology Department, Cra. 98 # 18-49, Cali, 760032, Colombia, Tel +576023319090; Ext 4022, Email
| | - David E Rebellón Sánchez
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Universidad Icesi, Cali, Colombia,Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, 760032, Colombia
| | - Daniela Torres-Salazar
- Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - Akemi Arango Sakamoto
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, 760032, Colombia
| | - Leidy Jhoanna López-Erazo
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - Iván F Quintero-Cifuentes
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - María A Vélez-Esquivia
- Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | | | - Antonio J T Suguimoto-Erasso
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| |
Collapse
|
11
|
Abhay P, Sharma R, Bhan A, Raina M, Vadhera A, Akole R, Mir FA, Bajpai P, Misri A, Srivastava S, Prakash V, Mondal T, Soundararajan A, Tibrewal A, Bansal SB, Sethi SK. Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery. Front Pediatr 2023; 11:1086626. [PMID: 36891234 PMCID: PMC9986414 DOI: 10.3389/fped.2023.1086626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction There is a need to index important clinical characteristics in pediatric cardiac surgery that can be obtained early in the postoperative period and accurately predict postoperative outcomes. Methodology A prospective cohort study was conducted in the pediatric cardiac ICU and ward on all children aged <18 years undergoing cardiac surgery for congenital heart disease from September 2018 to October 2020. The vasoactive-ventilation-renal (VVR) score was analyzed to predict outcomes of cardiac surgeries with a comparison of postoperative variables. Results A total of 199 children underwent cardiac surgery during the study period. The median (interquartile range) age was 2 (0.8-5) years, and the median weight was 9.3 (6-16) kg. The most common diagnoses were ventricular septal defect (46.2%) and tetralogy of Fallot (37.2%). At the 48th h, area under the curve (AUC) (95% CI) values were higher for the VVR score than those for other clinical scores measured. Similarly, at the 48th h, AUC (95% CI) values were higher for the VVR score than those for the other clinical scores measured for the length of stay and mechanical ventilation. Discussion The VVR score at 48 h postoperation was found to best correlate with prolonged pediatric intensive care unit (PICU) stay, length of hospitalization, and ventilation duration, with the greatest AUC-receiver operating characteristic (0.715, 0.723, and 0.843, respectively). The 48-h VVR score correlates well with prolonged ICU, hospital stay, and ventilation.
Collapse
Affiliation(s)
- Pota Abhay
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | - Rajesh Sharma
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | - Anil Bhan
- CTVS, Medanta-The Medicity, Gurgaon, India
| | - Manan Raina
- Hawken High School, Cleveland, OH, United States
| | | | - Romel Akole
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | | | - Pankaj Bajpai
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | - Amit Misri
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | | | | | - Tanmoy Mondal
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | - Anvitha Soundararajan
- Akron Nephrology Associates, Akron General Cleveland Clinic, Akron, OH, United States
| | - Abhishek Tibrewal
- Pediatric Nephrology, Akron's Children Hospital, Akron, OH, United States
| | | | | |
Collapse
|
12
|
Vachirapuranon S, Vijarnsorn C, Kanjanauthai S, Tocharoenchok T, Durongpisitkul K, Chanthong P, Chungsomprasong P, Pacharapakornpong T, Soongswang J, Rungmaitree S, Peerananrangsee C, Nitiyarom E, Tantiwongkosri K, Subtaweesin T, Phachiyanukul A. Major infections following pediatric cardiac surgery pre- and post-CLABSI bundle implementation. PeerJ 2022; 10:e14279. [PMID: 36325177 PMCID: PMC9620976 DOI: 10.7717/peerj.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background Postoperative infection contributes to the worsening of congenital cardiac surgery (CCS) outcomes. Surgical site infection (SSI), bloodstream infection (BSI) and ventilator associated pneumonia (VAP) are common. An additional bundle of preventive measures against central-line associated bloodstream infection (CLABSI) bundle was implemented in April 2019. Objectives To compare the incidence of major infections after pediatric CCS before and after the implementation of the CLABSI bundle and to identify risk factors for major infections. Methods We conducted a single-center, retrospective study to assess the incidence of major infections including bloodstream infection (BSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP) after pediatric CCS one year before and after implementation of the CLABSI bundle during April 2018-March 2020. The demographics and outcomes of the patients were explored, and risk factors for major infections were identified using multivariate analysis. Results A total of 548 children (53% male) underwent CCS with a median age of 1.9 years (range 0.01-17.5 years). The median Aristotle Basic Complexity score was 7.1 (range 3-14.5). The CLABSI bundle was applied in 262 patients. Overall mortality was 5.5%. 126 patients (23%) experienced major postoperative infections. During the year after the implementation of the CLABSI bundle, BSI was reduced from 8.4% to 3.1% (p = 0.01), with a smaller reduction in VAP (21% to 17.6%; p = 0.33). The incidence of SSI was unchanged (1.7% to 1.9%; p = 0.77). The independent risk factors for major infections were age at surgery <6 months (p = 0.04), postoperative ventilator usage >2 days (p < 0.01), central line usage >4 days (p = 0.04), and surgery during the pre-CLABSI bundle period (p = 0.01). Conclusion Following the implementation of the CLABSI prevention package in our pediatric CCS unit, the incidence of BSI was significantly reduced. The incidence of VAP tended to decrease, while the SSI was unchanged. Sustainability of the prevention package through nurse empowerment and compliance audits is an ongoing challenge.
Collapse
Affiliation(s)
- Somthida Vachirapuranon
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Tocharoenchok
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Krivikrom Durongpisitkul
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thita Pacharapakornpong
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charn Peerananrangsee
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekarat Nitiyarom
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thaworn Subtaweesin
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amornrat Phachiyanukul
- Pediatric Nursing Division, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
13
|
Neutrophil Count as Atrioventricular Block (AVB) Predictor following Pediatric Heart Surgery. Int J Mol Sci 2022; 23:ijms232012409. [PMID: 36293263 PMCID: PMC9604473 DOI: 10.3390/ijms232012409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022] Open
Abstract
Neutrophils play a significant role in immune and inflammatory reactions. The preoperative inflammatory activation may have a detrimental effect on postoperative outcomes. The aim of the study was to investigate the relation between preoperative hematological indices on postoperative complications’ risk in pediatric cardiac congenital surgery. The retrospective single center analysis included 93 pediatric patients (48 (65%) males and 45 (35%) females), mean age of 7 (3−30) months referred for cardiac surgery in cardiopulmonary bypass due to functional single ventricle disease (26 procedures), shunts lesions (40 procedures) and cyanotic disease (27 procedures). Among simple hematological indices, the receiver-operating-characteristic curve showed that a neutrophil count below 2.59 K/uL was found as an optimal cut-off point for predicting postoperative atrioventricular block following pediatric cardiac surgery (AUC = 0.845, p < 0.0001) yielding a sensitivity of 100% and a specificity of 65.62%. Preoperative values of neutrophil count below 2.59 K/uL in whole blood analysis can be regarded as a predictive factor (AUC = 0.845, p < 0.0001) for postoperative atrioventricular block in pediatric cardiac surgery.
Collapse
|
14
|
Kumar A, Joshi S, Tiwari N, Kumar V, Ramamurthy H, Kumar G, Sharma V. Comparative evaluation of high-flow nasal cannula oxygenation vs nasal intermittent ventilation in postoperative paediatric patients operated for acyanotic congenital cardiac defects. Med J Armed Forces India 2022; 78:454-462. [PMID: 36267502 PMCID: PMC9577337 DOI: 10.1016/j.mjafi.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/03/2021] [Indexed: 10/20/2022] Open
Abstract
Background This study aimed to compare high-flow nasal cannula (HFNC) oxygenation vs nasal intermittent ventilation (NIV) oxygenation for respiratory care after extubation in postoperative paediatric cardiac patients. Methods This study was a randomised controlled trial. One hundred twenty-one paediatric patients with acyanotic congenital heart disease undergoing corrective cardiac surgery on cardiopulmonary bypass were included in the study. Patients were randomised to receive either HFNC (AIRVO) or NIV (RAM Cannula) postextubation. Arterial blood gas was analysed at different time points perioperatively. Results Patients in both the groups were matched with respect to diagnosis and demographic profiles. Baseline hemodynamic and respiratory parameters were also similar in both the groups. Patients in HFNC/AIRVO group did not show improved carbon dioxide (CO2) washout but showed improved pO2 and pO2/FiO2 ratio immediate postextubation. Reintubation rate and other intensive care unit (ICU) complications were similar in both the groups. Conclusion Postcardiopulmonary bypass respiratory complications in paediatric patients with congenital acyanotic heart disease can be minimised with newer oxygen therapy devices such as AIRVO (HFNC) or RAM cannula (NIV). In comparison between these two, AIRVO did not show improved CO2 washout over RAM cannula; however, it did provide better oxygenation as measured by pO2 in arterial blood and pO2/FiO2 ratio immediate postextubation. Also, long-term results such as duration of mechanical ventilation and ICU stay were not affected by the choice of device.
Collapse
Affiliation(s)
- Alok Kumar
- Classified Specialist (Anaesthesia & Cardio-Thoracic Anaesthesia), Army Hospital (R&R), New Delhi, India
| | - Saajan Joshi
- Senior Advisor (Anaesthesia) & Trained in Paediatric Anaesthesia, Army Hospital (R&R), New Delhi, India
| | - Nikhil Tiwari
- Senior Advisor (Surgery) & Cardio-Thoracic Surgeon, Army Hospital (R&R), New Delhi, India
| | - Vivek Kumar
- Classified Specialist (Paediatric) & Trained in Paediatric Cardiology, Army Hospital (R&R), New Delhi, India
| | - H.R. Ramamurthy
- Senior Advisor (Paediatric) & Trained in Paediatric Cardiology, Army Hospital (R&R), New Delhi, India
| | - Gaurav Kumar
- Senior Consultant (Paediatric Cardiac Surgery), Fortis Hospital, Delhi, India
| | - Vipul Sharma
- Professor (Cardiac Anaesthesia), Dr. D.Y. Patil Medical College, Pune, India
| |
Collapse
|
15
|
Riley CM, Murphy LD, Mastropietro CW. Cardiac Arrest in Children Following Cardiac Surgery: A Scoping Review of Contributing Factors. World J Pediatr Congenit Heart Surg 2022; 13:475-481. [PMID: 35757944 DOI: 10.1177/21501351221100791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nearly half of children experiencing cardiac arrest following cardiac surgery do not survive hospital discharge and patients who survive often experience significant neurological impairment. Additionally, increased resource utilization following cardiac arrest translates into adverse logistical and financial consequences. Although some studies have identified patient characteristics that increase the risk of cardiac arrest after pediatric cardiac surgery, modifiable risk factors, which could provide a foundation for effective prevention strategies, have been elusive. This scoping review explores the current knowledge surrounding risk factors associated with cardiac arrest in children following cardiac surgery and provides recommendations for future research.
Collapse
Affiliation(s)
| | - Lee D Murphy
- Indiana University School of Medicine, Riley 548952Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Christopher W Mastropietro
- Indiana University School of Medicine, Riley 548952Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| |
Collapse
|
16
|
Sainathan S, Agala CB, Said SM, Mulinari L, Sharma MS. National Fontan Operation short-term outcomes at or below 2-years-of-age compared to older than 2-years-of-age. J Card Surg 2022; 37:1567-1573. [PMID: 35324033 DOI: 10.1111/jocs.16424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Opinion is divided about optimal early timing of the Fontan Operation (FO). While some studies have suggested 3 years-of-age, others have shown good outcomes below 2 years-of-age. We analyzed the impact of age ≤2 years as compared age >2 years on short-term outcome of the FO using a large national database. METHODS A retrospective analysis of the Kids Inpatient Database (2009-16) for the FO was done. The groups were divided into those who underwent FO at age ≤2 years (Early FO [EF]) as compared to age >2 years (Late FO [LF]). The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. RESULTS A total of 3381 patients underwent FO during this period of which 1482 (44%) were EF. The mean ages of the EF and LF were 1.6 and 4.3, respectively (p < .001). LF were more likely to be non-White, female, and have Heterotaxy syndrome. HLHS was more common in EF. There was no difference in the discharge mortality, length of stay, disposition (majority went home), and mean total charges incurred. The overall discharge mortality was low at 0.7% (24/3381). In multivariate analysis: cardiac arrest, acute kidney injury, mechanical ventilation >96 h, endocardial cushion defect and non-White ethnicity were predictors of a mortality and not age. CONCLUSION Contemporary outcomes for FO are excellent with equivalent short-term outcomes in both the age groups. Occurrence of postoperative complications, non-White ethnicity and endocardial cushion defect diagnosis were predictive of a negative outcome.
Collapse
Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA.,Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chris B Agala
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sameh M Said
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Leonardo Mulinari
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA
| | - Mahesh S Sharma
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
17
|
Mid-regional pro-adrenomedullin for diagnosing evolution after cardiac surgery in newborns: the PRONEW study. Eur J Pediatr 2022; 181:1017-1028. [PMID: 34686907 DOI: 10.1007/s00431-021-04278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
Newborns are the most vulnerable patients after cardiac surgery. Although mortality risk scores before surgery may help predict the risk of poor outcome, new tools are required, and biomarkers could add objective data to these tools. The aim of this study was to assess the ability of mid-regional pro-adrenomedullin (pro-ADM) and pro-atrial natriuretic peptide (pro-ANP) to predict poor outcome after cardiac surgery. This is a pilot diagnostic accuracy study that includes newborns and infants under 2 months admitted to an intensive care unit after cardiac surgery. Pro-ADM and pro-ANP were determined immediately upon admission. Poor outcome was defined as mortality, cardiac arrest, requiring extracorporeal support, requiring renal replacement therapy, or neurological injury. Forty-four patients were included. Twenty-six (59%) had a STAT category of ≥ 4. Ten patients (22.7%) presented a poor outcome, four of whom (9.1%) died. Pro-ADM was higher in patients with poor outcome (p = 0.024) and death (p = 0.012). Pro-ADM showed the best area under curve (AUC) for predicting poor outcome (0.735) and mortality alone (0.869). A pro-ADM of 2 nmol/L had a Sn of 75% and a Sp of 85% for predicting mortality. Pro-ADM > 2 nmol/L was independently associated with poor outcome (OR 5.8) and mortality (OR 14.1). Although higher pro-ANP values were associated with poor outcomes, no cut-off point were found. The combination of STAT ≥ 4 and the biomarkers did not enhance predictive power for poor outcome or mortality.Conclusion: Pro-ADM and pro-ANP determined immediately after surgery could be helpful for stratifying risk of poor outcome and mortality in newborns. What is Known: • Some congenital heart diseases must be corrected/palliated during the first days of life. A useful tool to predict the risk of severe complications has not been proposed. • Most unstable newborns would have higher values of biomarkers such as pro-ADM and pro-ANP related to shock and compensatory actions. What is New: • Pro-ADM and pro-ANP seem to be good biomarkers to predict poor outcome after cardiac surgery. A pro-ADM < 2 nmol/L would imply a low likelihood of a poor outcome. • Deepening the analysis of biomarkers can help in making decisions to prevent/treat complications.
Collapse
|
18
|
Comparison of Postoperative, In-Hospital Outcomes After Complete Repair of Tetralogy of Fallot Between 22q11.2 Deletion Syndrome and Trisomy 21. Pediatr Cardiol 2022; 43:290-300. [PMID: 34331082 DOI: 10.1007/s00246-021-02683-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
22q11.2 deletion syndrome (22q11) and trisomy 21 (T21) are frequently associated with tetralogy of Fallot (TOF). We hypothesized that there are differences in postoperative length of stay (LOS) and occurrence of postoperative interventions after complete repair of TOF when comparing children with 22q11 to those with T21. Using the Pediatric Health Information System, we performed a retrospective cohort study of patients who underwent complete repair of TOF from 2004 to 2019. Three groups were identified: 22q11, T21, and controls (those without a coded genetic syndrome). Outcomes were postoperative LOS and composite occurrence (yes/no) of at least one postoperative intervention. Bivariate and multivariate comparisons were made among groups; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the control group as the comparator. There were 6924 subjects (n = 493 22q11, n = 455 T21, n = 5976 controls). In bivariate analysis, 22q11 was associated with a longer LOS compared to T21 (OR 2.37 [2.16, 2.60] vs. 1.25 [1.12, 1.39], p < 0.001), and 22q11 more often underwent postoperative intervention (OR 3.42 [CI 2.56, 4.57] vs. 1.38 [CI 0.91, 2.11]; p < 0.001). In multivariate analysis, 22q11 was also associated with longer LOS (adjusted OR 1.35 [1.26, 1.44] vs. 1.12 [1.04, 1.20]; p < 0.001), but there was no difference in the adjusted odds of postoperative intervention. Children with 22q11 are more likely to experience adverse outcomes after repair of TOF compared to those with T21; the differences are most pronounced for LOS.
Collapse
|
19
|
Risk Factors and Consequences of Acute Kidney Injury After Noncardiac Surgery in Children. Anesth Analg 2022; 135:625-632. [PMID: 35086116 DOI: 10.1213/ane.0000000000005901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a serious complication that is associated with prolonged hospital stay, high risk of short-term postsurgical mortality, need for dialysis, and possible progression to chronic kidney disease. To date, very little data exist on the risk of postoperative AKI among children undergoing noncardiac surgical procedures. We used data from a large multicenter cohort to determine the factors associated with AKI among children who underwent inpatient noncardiac surgical procedures and its impact on the postoperative course. METHODS We utilized the National Surgical Quality Improvement Program Pediatric participant user files to identify a cohort of children who underwent inpatient surgery between 2012 and 2018 (n = 257,439). We randomly divided the study population into a derivation cohort of 193,082 (75%) and a validation cohort of 64,357 (25%), and constructed a multivariable logistic regression model to identify independent risk factors for AKI. We defined AKI as the occurrence of either acute renal failure or progressive renal insufficiency within the 30 days after surgery. RESULTS The overall rate of postoperative AKI was 0.10% (95% confidence interval [CI], 0.09-0.11). In a multivariable model, operating times longer than 140 minutes, preexisting hematologic disorder, and preoperative sepsis were the strongest independent predictors of AKI. Other independent risk factors for AKI were American Society of Anesthesiologists (ASA) physical status ≥III, preoperative inotropic support, gastrointestinal disease, ventilator dependency, and corticosteroid use. The 30-day mortality rate was 10.1% in children who developed AKI and 0.19% in their counterparts without AKI (P < .001). Children who developed AKI were more likely to require an extended hospital stay (≥75th percentile of the study cohort) relative to their peers without AKI (77.4% vs 21.0%; P < .001). CONCLUSIONS Independent preoperative risk factors for AKI in children undergoing inpatient noncardiac surgery were hematologic disorder, preoperative sepsis, ASA physical status ≥III, inotropic support, gastrointestinal disease, ventilator dependency, and steroid use. Children with AKI were 10 times more likely to die and nearly 3 times more likely to require an extended hospital stay, relative to their peers without AKI.
Collapse
|
20
|
Zheng G, Wu J, Chen P, Hu Y, Zhang H, Wang J, Zeng H, Li X, Sun Y, Xu G, Wen S, Cen J, Chen J, Guo Y, Zhuang J. Characteristics of in-hospital mortality of congenital heart disease (CHD) after surgical treatment in children from 2005 to 2017: a single-center experience. BMC Pediatr 2021; 21:521. [PMID: 34814864 PMCID: PMC8609813 DOI: 10.1186/s12887-021-02935-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate trends in the in-hospital mortality rate for pediatric cardiac surgery procedures between 2005 and 2017 in our center, and to discuss the mortality characteristics of children’s CHD after thoracotomy. Methods This retrospective data were collected from medical records of children underwent CHD surgery between 2005 and 2017. Results A total of 19,114 children with CHD underwent surgery and 444 children died, with the in-hospital mortality was 2.3%. Complex mixed defect CHD had the highest fatality rate (8.63%), left obstructive lesion CHD had the second highest fatality rate (4.49%), right to left shunt CHD had the third highest mortality rate (3.51%), left to right shunt CHD had the lowest mortality rate (χ2 = 520.3,P < 0.05). The neonatal period has the highest mortality rate (12.17%), followed by infant mortality (2.58%), toddler age mortality (1.16%), and preschool age mortality (0.94%), the school age and adolescent mortality rate was the lowest (χ2 = 529.3,P < 0.05). In addition, the fatality rate in boys was significantly higher than that in girls (2.77% versus 1.62%, χ2 = 26.4, P < 0.05). Conclusions The mortality rate of CHD surgery in children decreased year by year. The younger the age and the more complicated the cyanotic heart disease, the higher the mortality rate may be.
Collapse
Affiliation(s)
- Guilang Zheng
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaxing Wu
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peiling Chen
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Hu
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huiqiong Zhang
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Wang
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hanshi Zeng
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xufeng Li
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yueyu Sun
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gang Xu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China.
| | - Yuxiong Guo
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China.
| |
Collapse
|
21
|
Miana LA, Nathan M, Tenório DF, Manuel V, Guerreiro G, Fernandes N, Campos CVD, Gaiolla PV, Cassar RS, Turquetto A, Amato L, Canêo LF, Daroda LL, Jatene MB, Jatene FB. Translation and Validation of the Boston Technical Performance Score in a Developing Country. Braz J Cardiovasc Surg 2021; 36:589-598. [PMID: 34787990 PMCID: PMC8597612 DOI: 10.21470/1678-9741-2021-0485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.
Collapse
Affiliation(s)
- Leonardo A Miana
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Davi Freitas Tenório
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Valdano Manuel
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Cardiovascular Surgery Division, Clínica Girassol, Luanda, Angola
| | - Gustavo Guerreiro
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Natália Fernandes
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carolina Vieira de Campos
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Paula V Gaiolla
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Renata Sá Cassar
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Aida Turquetto
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luciana Amato
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz Fernando Canêo
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Marcelo Biscegli Jatene
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Pediatric Cardiology and Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), Universidade de São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
22
|
Yang L, Liu X, Chen Y, Shen B. An update on the CHDGKB for the systematic understanding of risk factors associated with non-syndromic congenital heart disease. Comput Struct Biotechnol J 2021; 19:5741-5751. [PMID: 34765091 PMCID: PMC8556603 DOI: 10.1016/j.csbj.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/29/2021] [Accepted: 10/10/2021] [Indexed: 02/05/2023] Open
Abstract
The Congenital Heart Disease Genetic Knowledge Base (CHDGKB) was established in 2020 to provide comprehensive knowledge about the genetics and pathogenesis of non-syndromic CHD (NS-CHD). In addition to the genetic causes of NS-CHD, environmental factors such as maternal drug use and gene-environment interactions can also lead to CHD. There is a need to integrate this information into a platform for clinicians and researchers to better understand the overall risk factors associated with NS-CHD. The updated CHDGKB contains the genetic and non-genetic risk factors from over 4200 records from PubMed that was manually curated to include the information associated with NS-CHD. The current version of CHDGKB, named CHD-RF-KB (KnowledgeBase for non-syndromic Congenital Heart Disease-associated Risk Factors), is an important tool that allows users to evaluate the recurrence risk and prognosis of NS-CHD, to guide treatment and highlight the precautions of NS-CHD. In this update, we performed extensive functional analyses of the genetic and non-genetic risk information in CHD-RF-KB. These data can be used to systematically understand the heterogeneous relationship between risk factors and NS-CHD phenotypes.
Collapse
Affiliation(s)
- Lan Yang
- Center of Prenatal Diagnosis, Wuxi Maternal and Child Health Hospital affiliated to Nanjing Medical University, Wuxi, China
- Center for Systems Biology, Soochow University, Suzhou 215006, China
| | - Xingyun Liu
- Center for Systems Biology, Soochow University, Suzhou 215006, China
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yalan Chen
- Center for Systems Biology, Soochow University, Suzhou 215006, China
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
23
|
Zeng X, Hu Y, Shu L, Li J, Duan H, Shu Q, Li H. Explainable machine-learning predictions for complications after pediatric congenital heart surgery. Sci Rep 2021; 11:17244. [PMID: 34446783 PMCID: PMC8390484 DOI: 10.1038/s41598-021-96721-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
The quality of treatment and prognosis after pediatric congenital heart surgery remains unsatisfactory. A reliable prediction model for postoperative complications of congenital heart surgery patients is essential to enable prompt initiation of therapy and improve the quality of prognosis. Here, we develop an interpretable machine-learning-based model that integrates patient demographics, surgery-specific features and intraoperative blood pressure data for accurately predicting complications after pediatric congenital heart surgery. We used blood pressure variability and the k-means algorithm combined with a smoothed formulation of dynamic time wrapping to extract features from time-series data. In addition, SHAP framework was used to provide explanations of the prediction. Our model achieved the best performance both in binary and multi-label classification compared with other consensus-based risk models. In addition, this explainable model explains why a prediction was made to help improve the clinical understanding of complication risk and generate actionable knowledge in practice. The combination of model performance and interpretability is easy for clinicians to trust and provide insight into how they should respond before the condition worsens after pediatric congenital heart surgery.
Collapse
Affiliation(s)
- Xian Zeng
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yaoqin Hu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Liqi Shu
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, USA
| | - Jianhua Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
| | - Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
24
|
Pode Shakked N, Rosenblat O, Sagiv D, Molad J, Weinberg H, Shlomo M, Tokatly Latzer I, Pleniceanu O, Mishali D, Vardi A, Hemi R, Kanety H, Paret G. Protective effect of soluble Klotho in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass support-A pilot study. J Card Surg 2021; 36:3567-3576. [PMID: 34350997 DOI: 10.1111/jocs.15849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The Klotho protein family plays important roles in several metabolic pathways. Soluble Klotho has been recently put forward as an antiaging protein, demonstrating renal and cardiovascular protective traits. Cardiopulmonary bypass (CPB) support during cardiac surgery has been implicated in several adverse outcomes in pediatric and adult patients. Our goal was to assess whether serum Klotho levels can be used to predict outcomes in children undergoing cardiac surgery with CPB due to congenital heart defects (CHDs). METHODS This prospective study was conducted on pediatric patients admitted to two Pediatric Cardiac Intensive Care Units, between 2012 and 2018. All patients were born with CHD and underwent corrective surgery with CPB. Sequential blood samples were analyzed by enzyme-linked immunosorbent assay for soluble Klotho levels at baseline, 2, 6, and 24 h after surgery. The association between Klotho levels and several demographic, intraoperative, and postoperative clinical and laboratory parameters was studied. RESULTS Twenty-nine children undergoing cardiac surgery with CPB support were included. Serum Klotho levels were shown to significantly decrease 2 h after surgery and increase to baseline levels after 6 h (p < .001 and p < .05, respectively). Patients with low Klotho levels 2 h after surgery were at a 32-fold higher risk for developing postoperative complications (p = .015, odds ratio < 0.03). Moreover, Klotho levels at each of the four time points were lower in patients who developed postoperative complications. CONCLUSIONS Cardiac surgery with CPB results in a significant decrease of serum Klotho levels 2 h after surgery in pediatric patients with CHDs, which can be used to predict development of postoperative complications in this patient population.
Collapse
Affiliation(s)
- Naomi Pode Shakked
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,The Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Orgad Rosenblat
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Doron Sagiv
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.,Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Jeremy Molad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagai Weinberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine B, Meir Medical Center, Kfar Saba, Israel
| | - Meital Shlomo
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Itay Tokatly Latzer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Oren Pleniceanu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Kidney Research Lab, The Institute of Nephrology and Hypertension, Sheba Medical Center, Tel-Hashomer, Israel
| | - David Mishali
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond and Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amir Vardi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Cardiac Intensive Care Unit, Edmond and Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Rina Hemi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Hannah Kanety
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gideon Paret
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pediatric Intensive Care, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
25
|
Zubarioglu AU, Yıldırım Ö, Zeybek C, Balaban İ, Yazıcıoglu V, Aliyev B. Validation of the Vasoactive-Ventilation-Renal Score for Neonatal Heart Surgery. Cureus 2021; 13:e15110. [PMID: 34026389 PMCID: PMC8132479 DOI: 10.7759/cureus.15110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare it with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which the VVR score should be measured. METHODS We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48, and 72 hours postoperatively. Max values, defined as the highest of the four scores, were also recorded. The main end result of interest was a composite outcome which included prolonged intensive care unit stay and mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling was also performed. RESULTS We reviewed 73 neonates and 21 of them showed composite outcomes. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72-hour max (AUC= 0.967; 95% confidence interval, (0.927-1). On multivariable regression analysis, the VVR max 72 hours remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.452; 95% confidence interval, 1.036-2.035). CONCLUSIONS We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow-up in postoperative 72 hours is superior to other indices and especially the maximum VVR value is a potentially powerful clinical tool to predict ICU stay and mortality.
Collapse
Affiliation(s)
| | - Özgür Yıldırım
- Cardiovascular Surgery, Yeni Yuzyıl University, Istanbul, TUR
| | - Cenap Zeybek
- Pediatric Cardiology, Yeni Yuzyıl University, Istanbul, TUR
| | - İsmail Balaban
- Pediatric Cardiology, Yeni Yuzyıl University, Istanbul, TUR
| | | | - Bahruz Aliyev
- Pediatric Cardiology, Yeni Yuzyıl University, Istanbul, TUR
| |
Collapse
|
26
|
Sterling LH, Liu A, Ganni E, Therrien J, Dancea AB, Guo L, Marelli AJ. Neurocognitive disorders amongst patients with congenital heart disease undergoing procedures in childhood. Int J Cardiol 2021; 336:47-53. [PMID: 33965470 DOI: 10.1016/j.ijcard.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/28/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amongst children with congenital heart disease (CHD), earlier age of repair improves cardiovascular outcomes. The effects of early intervention on neurodevelopment remains unclear. We assessed the association between early life repair, cardiopulmonary bypass (CPB) and the incidence of neurocognitive disorders (NCD) amongst CHD patients. METHODS We created two retrospective cohorts from the Quebec CHD Database; with data from 1988 to 2010. Complexity of reparative procedures for CHD lesions were used as the proxy of CPB exposure with more complex procedure means longer exposure to CPB. Study Population 1 included pediatric patients with a single reparative procedure and compared patients with complex (long CBP) versus isolated shunt (short CBP) lesions. To assess the effects of CPB alone in Study Population 2 we compared patients with isolated atrial septal defects (ASD) who had surgical (short CBP) versus percutaneous (no CBP) repairs. The primary endpoint for both cohorts was development of an NCD. RESULTS In Study population 1, 1174 patients underwent complex surgical repair and 1620 had a shunt closure. The incidence of NCDs was 2.45/100 person-years in the complex surgery group, and 2.08/100 person-years in the shunt closure group. The following were associated with increased risk of developing a NCD: surgical complexity (Hazard Ratio [HR] = 1.20, 95% Confidence Interval [CI]: 1.01-1.42), younger age at intervention (AAI) (HR = 1.20, 95% CI: 1.16-1.25), male sex (HR = 1.91, 95% CI: 1.61-2.27), and later calendar year at intervention (HR = 1.06, 95% CI: 1.04-1.07). Study population 2 had 527 isolated ASD patients; 202 underwent surgical repair and 325 had percutaneous closure. The incidence of NCDs was not statistically different between groups. Male sex (HR = 1.77, 95% CI: 1.08-2.89) and younger AAI (HR = 1.15, 95% CI: 1.06-1.25) were associated with increased NCD risk. CONCLUSION Increased surgical complexity, male sex and younger AAI were associated with increased risk of NCDs in pediatric CHD patients. Surveillance protocols should be considered to identify NCDs in CHD patients after cardiac intervention.
Collapse
Affiliation(s)
- Lee H Sterling
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aihua Liu
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Elie Ganni
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Judith Therrien
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Adrian B Dancea
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Liming Guo
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada
| | - Ariane J Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, QC, Canada.
| |
Collapse
|
27
|
Erek E, Yalçınbaş YK, Sarıosmanoğlu N, Özkan M, Yıldız O, Şenkaya I, Özdemir F, Biçer M, Sarıtaş AB, Atay Y, Seçici S, Kutsal A, Haydin S, Bilen C, Onan IS, Tuncer ON, Citoglu G, Doğan A, Turkoz R, Temur B, Koc M, Sarıoğlu CT. First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting. World J Pediatr Congenit Heart Surg 2021; 12:377-386. [PMID: 33942691 DOI: 10.1177/2150135121995474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A new congenital heart surgery database (CKCV) with real-time online reporting function was recently developed in Turkey. All standard international parameters were used, but Aristotle Comprehensive Complexity score was modified. In this study, the first analysis of the CKCV Database is reported. METHODS The CKCV Database included 2307 procedures from 12 centers between January 2018 and March 2020. All parameters, including 10 real-time online reports, which represent the number of centers, number and mortality rates of all procedures, number of extracorporeal membrane oxygenation (ECMO) and results, details of postoperative complications, age-group statistics, analysis for priority status, mean intensive care and hospital stay durations of the procedures, results of Aristotle Basic, Modified Aristotle Comprehensive (MACC) and Society of Thoracic Surgeons-European Association (STAT) Score Categories, comparison of centers were analyzed. RESULTS Most common 10 procedures were ventricular septal defect (VSD) repair (n = 273), tetralogy of Fallot (TOF) repair (n = 243), atrial septal defect (ASD) repair (n = 181), complete AVSD repair (n = 95), cavopulmonary anastomosis (n = 81), systemic to pulmonary shunt (n = 79), modified Fontan (n = 71), subaortic resection, (n = 66) PA banding (n = 66), and arterial switch operation (n = 66). Cardiopulmonary bypass was used in 84.6% of the procedures. Overall mortality rate was 6.0%. A total of 618 major and 570 minor complications were observed in 333 and 412 patients, respectively. According to six MACC categories, number of the patients and mortality rates were I (293; 0.3%); II (713; 1.4%); III (601; 3.3%); IV (607; 12%); V (84; 35.7%); and VI (9; 55.6%), respectively. Analysis of five STAT Categories showed 0.7, 3.8, 5.4, 14.9, and 54.7% mortality rates. CONCLUSIONS CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.
Collapse
Affiliation(s)
- Ersin Erek
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey.,Children Heart Foundation, Istanbul, Turkey
| | - Yusuf Kenan Yalçınbaş
- Children Heart Foundation, Istanbul, Turkey.,Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Nejat Sarıosmanoğlu
- Health Sciences University, Dr. Behçet Uz Training and Research Hospital, Izmir
| | - Murat Özkan
- Başkent University, Ankara Hospital, Ankara, Turkey
| | - Okan Yıldız
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | | | - Fatih Özdemir
- Health Sciences University, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Biçer
- Health Sciences University, Erzurum Training and Research Hospital, Erzurum, Turkey
| | | | | | | | - Ali Kutsal
- Health Sciences University, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Sertac Haydin
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | - Cagatay Bilen
- Health Sciences University, Dr. Behçet Uz Training and Research Hospital, Izmir
| | - Ismihan Selen Onan
- Health Sciences University, Istanbul Mehmet Akif Ersoy Training and Research Hospital, Istanbul, Turkey
| | | | | | | | - Riza Turkoz
- Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Bahar Temur
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - Murat Koc
- Health Sciences University, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - C Tayyar Sarıoğlu
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Istanbul, Turkey.,Children Heart Foundation, Istanbul, Turkey.,Acibadem Bakirkoy Hospital, Istanbul, Turkey
| |
Collapse
|
28
|
Adams PS, Corcoran TE, Lin JH, Weiner DJ, Sanchez-de-Toledo J, Lo CW. Mucociliary Clearance Scans Show Infants Undergoing Congenital Cardiac Surgery Have Poor Airway Clearance Function. Front Cardiovasc Med 2021; 8:652158. [PMID: 33969015 PMCID: PMC8102682 DOI: 10.3389/fcvm.2021.652158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Infants undergoing congenital cardiac surgery with cardiopulmonary bypass are at high risk for respiratory complications. As impaired airway mucociliary clearance (MCC) can potentially contribute to pulmonary morbidity, our study objective was to measure airway clearance in infants undergoing congenital cardiac surgery and examine correlation with clinical covariables that may impair airway clearance function. Materials and Methods: Airway clearance in infants was measured over 30 min using inhaled nebulized Technetium 99m sulfur colloid administered either via a nasal cannula or the endotracheal tube in intubated infants. This was conducted bedside with a portable gamma camera. No difficulty was encountered in positioning the gamma camera over the patient, and neither the camera nor the MCC scan interfered with routine medical care or caused any adverse events. Patient and perioperative variables were examined relative to the MCC measurements. Results: We prospectively enrolled 57 infants undergoing congenital cardiac surgery and conducted a single MCC scan per patient. MCC data from 42 patients were analyzable, including five pre-operative, 15 (40.5%) in the immediate post-operative period (days 1-2), and 22 (59.5%) were later post-operative (≥3 days). Pre-operative MCC was inversely proportional to days requiring post-operative mechanical ventilation (p = 0.006) and non-invasive positive pressure ventilation (p = 0.017). MCC was higher at later post-operative days (p = 0.002) with immediate post-operative MCC being lower (3%; 0-13%) than either pre-operative (21%; 4-25%) (p = 0.091) or later post-operative MCC (18%; 0-29%) (p = 0.054). Among the infants with low post-operative MCC, significantly more were pre-mature [5/19 (26%) vs. 0/18 (0%); p = 0.046], were intubated [14/19 (75%) vs. only 7/18 (39%); p = 0.033] and were receiving higher FiO2 (40%, 27-47% vs. 26%, 21-37%; p = 0.015). Conclusions: This is the first study to show that infants undergoing congenital cardiac surgery have impaired MCC. MCC appeared lowest in the immediate post-operative period. Worse MCC was associated with pre-maturity, mechanical ventilation, or receiving higher FiO2. These findings suggest MCC scans should be further explored for informing clinical decision making to improve post-surgical respiratory outcomes. The possible therapeutic benefit of airway clearance maneuvers for infants with poor MCC function should also be investigated.
Collapse
Affiliation(s)
- Phillip S Adams
- Division of Pediatric Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Timothy E Corcoran
- Division of Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jiuann-Huey Lin
- Division of Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Daniel J Weiner
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Joan Sanchez-de-Toledo
- Division of Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
29
|
Alshaya MA, Almutairi NS, Shaath GA, Aldosari RA, Alnami SK, Althubaiti A, Abu-Sulaiman RM. Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors. J Saudi Heart Assoc 2021; 33:1-8. [PMID: 33880325 PMCID: PMC8051332 DOI: 10.37616/2212-5043.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery. METHODS Patients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed. RESULTS The SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3-13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4-7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1-8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2-5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%]. CONCLUSIONS SSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.
Collapse
Affiliation(s)
- Milad A. Alshaya
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Nouf S. Almutairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Ghassan A. Shaath
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh,
Saudi Arabia
| | - Rahmah A. Aldosari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Sadeem K. Alnami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Alaa Althubaiti
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah,
Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah,
Saudi Arabia
| | - Riyadh M. Abu-Sulaiman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh,
Saudi Arabia
| |
Collapse
|
30
|
Feng D, Christensen JT, Yetman AT, Lindsey ML, Singh AB, Salomon JD. The microbiome’s relationship with congenital heart disease: more than a gut feeling. JOURNAL OF CONGENITAL CARDIOLOGY 2021. [DOI: 10.1186/s40949-021-00060-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractPatients with congenital heart disease (CHD) are at risk for developing intestinal dysbiosis and intestinal epithelial barrier dysfunction due to abnormal gut perfusion or hypoxemia in the context of low cardiac output or cyanosis. Intestinal dysbiosis may contribute to systemic inflammation thereby worsening clinical outcomes in this patient population. Despite significant advances in the management and survival of patients with CHD, morbidity remains significant and questions have arisen as to the role of the microbiome in the inflammatory process. Intestinal dysbiosis and barrier dysfunction experienced in this patient population are increasingly implicated in critical illness. This review highlights possible CHD-microbiome interactions, illustrates underlying signaling mechanisms, and discusses future directions and therapeutic translation of the basic research.
Collapse
|
31
|
Donahue BS. Commentary: Coagulation Testing in Pediatric Cardiac Surgery: The Small Picture and the Big Picture. Semin Thorac Cardiovasc Surg 2021; 34:291-292. [PMID: 33662556 DOI: 10.1053/j.semtcvs.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Brian S Donahue
- Division of Pediatric Cardiac Anesthesia, Departments of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
32
|
Elsisy MF, Dearani JA, Crestanello JA, Ashikhmina EA, Van Dorn CS, Stephens EH. Outcomes of Primary vs Secondary Delayed Sternal Closure in Pediatric Cardiac Surgery. Ann Thorac Surg 2021; 113:1231-1237. [PMID: 33662305 DOI: 10.1016/j.athoracsur.2021.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delayed sternal closure (DSC) is a management strategy for hemodynamic instability and severe coagulopathy after complex congenital heart surgery. We hypothesized that DSC results in better outcomes than perioperative sternal reopening. METHODS We reviewed patients aged <18 years old undergoing cardiac surgery 2007-2017 at our institution. A total of 179 patients (3.8%) had primary DSC (PDSC, sternum left open after initial operation) and 45 patients (0.9%) had secondary DSC (SDSC, sternum closed primarily and reopened perioperatively). Perioperative characteristics and outcomes among PDSC ≤2 days (98 patients), PDSC >2 days (81 patients), and SDSC (45 patients) were analyzed. RESULTS Median age was 120 days (range, 3-6553 days) and median DSC duration was 2 days (range, 1-60 days). The PDSC >2 days group was the youngest group, and the distribution of procedures was different between groups. Indications for DSC were hemodynamic instability in 152 patients (67.9%) and severe coagulopathy in 33 patients (14.7%), with no difference between groups (P = .141). Extracorporeal membrane oxygenation use was higher in the PDSC >2 days group than the other groups (47.5% vs 7.1%, P < .01 and 47.5% vs 28.9%, P = .02), respectively. Operative mortality was higher in SDSC compared to the other groups (17.8% vs 0% for PDSC ≤2 and 6.2% for PDSC >2 days, P < .01). Hospital stay was longer in SDSC (57 ± 7 days) than PDSC ≤2 days (22 ± 5 days) and PDSC >2 days (44 ± 6, P = .01). Survival was better in PDSC regardless of duration than SDSC. CONCLUSIONS PDSC demonstrated better outcomes than SDSC. Sternal reopening can be life-saving, but, when anticipated, PDSC can yield better outcomes.
Collapse
Affiliation(s)
- Mohamed F Elsisy
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Elena A Ashikhmina
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charlotte S Van Dorn
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
33
|
Rebolledo MA, Kumar TKS, Tansey JB, Pickens B, Allen J, Hanafin HJ, Boston US, Knott-Craig CJ. Single Institution Experience With International Referrals for Pediatric Cardiac Surgery. World J Pediatr Congenit Heart Surg 2020; 11:727-732. [PMID: 33164680 DOI: 10.1177/2150135120937230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric cardiac surgery in developing countries poses many challenges. The practice of referring patients from abroad via nongovernmental organizations has occurred for many years. We describe our experience with international referrals for pediatric cardiac surgery via Gift of Life Mid-South to the Heart Institute, Le Bonheur Children's Hospital in Memphis, Tennessee. METHODS We performed a retrospective descriptive review of data collected in our Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) along with data from our electronic medical record from January 1, 2007, to December 31, 2017. Available data included patient demographics, diagnoses, surgical procedure, entire inpatient length of stay (LOS), complications, and operative mortality. Cardiac surgeries were grouped according to the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories). Complications were defined according to the STS CHSD. RESULTS In this retrospective descriptive study, case complexity level varied; however, 38% cardiac surgeries were in STAT Mortality Category 3 or 4. Honduras was the most common referral source with a total of 18 countries represented. Operative mortality remained very low (1 [1.4%] of 71 cardiac surgeries) despite patients being referred beyond infancy. There were an increasing number of complications and longer inpatient LOS (with greater variance) in STAT Mortality Category 4. CONCLUSIONS International patients referred for congenital heart surgery can be successfully treated with an acceptable mortality rate despite late referrals. Inpatient LOS is related to surgical complexity. Follow-up studies are needed to determine the long-term outcomes of these patients.
Collapse
Affiliation(s)
- Michael A Rebolledo
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - James B Tansey
- College of Medicine, 12325The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jerry Allen
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - H Jane Hanafin
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Umar S Boston
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Christopher J Knott-Craig
- The University of Tennessee Health Science Center and The Heart Institute, 14505Le Bonheur Children's Hospital, Memphis, TN, USA
| |
Collapse
|
34
|
Abstract
BACKGROUND The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries. AIM To evaluate perioperative complications rate, mortality related to complications, different patients' demographics, and procedural risk factors for perioperative complication and post-operative death. METHODS Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery. RESULTS Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality - 8.1% among patients with only 1 perioperative complication, 35.3% - with 2 perioperative complications, and 42.1% - with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37). CONCLUSIONS In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.
Collapse
|
35
|
Sharma A, Chakraborty R, Sharma K, Sethi SK, Raina R. Development of acute kidney injury following pediatric cardiac surgery. Kidney Res Clin Pract 2020; 39:259-268. [PMID: 32773391 PMCID: PMC7530361 DOI: 10.23876/j.krcp.20.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022] Open
Abstract
Acute kidney injury (AKI) in the pediatric population is a relatively common phenomenon. Specifically, AKI has been found in increasing numbers within the pediatric population following cardiac surgery, with up to 43% of pediatric patients developing AKI post-cardiac surgery. However, recent advances have allowed for the identification of risk factors. These can be divided into preoperative, intraoperative, and postoperative factors. Although the majority of pediatric patients developing AKI after cardiac surgery completely recover, this condition is associated with worse outcomes. These include fluid overload and increased mortality and result in longer hospital and intensive care unit stays. Detecting the presence of AKI has advanced; use of relatively novel biomarkers, including neutrophil gelatinase associated lipocalin, has shown promise in detecting more subtle changes in kidney function when compared to conventional methods. While a single, superior treatment has not been elucidated yet, novel functions of medications, including fenoldopam, theophylline and aminophylline, have been shown to have better outcomes for these patients. With the recent advances in identification of risk factors, outcomes, diagnosis, and management, the medical community can further explain the complexities of AKI in the pediatric population post-cardiac surgery.
Collapse
Affiliation(s)
- Aditya Sharma
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General Medical Center/Akron Nephrology Associates, Akron, OH, USA
| | - Katyayini Sharma
- Department of Medicine, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Sidharth K Sethi
- Department of Pediatric Nephrology and Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General Medical Center/Akron Nephrology Associates, Akron, OH, USA.,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| |
Collapse
|
36
|
Nees SN, Chung WK. Genetic Basis of Human Congenital Heart Disease. Cold Spring Harb Perspect Biol 2020; 12:cshperspect.a036749. [PMID: 31818857 DOI: 10.1101/cshperspect.a036749] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Congenital heart disease (CHD) is the most common major congenital anomaly with an incidence of ∼1% of live births and is a significant cause of birth defect-related mortality. The genetic mechanisms underlying the development of CHD are complex and remain incompletely understood. Known genetic causes include all classes of genetic variation including chromosomal aneuploidies, copy number variants, and rare and common single-nucleotide variants, which can be either de novo or inherited. Among patients with CHD, ∼8%-12% have a chromosomal abnormality or aneuploidy, between 3% and 25% have a copy number variation, and 3%-5% have a single-gene defect in an established CHD gene with higher likelihood of identifying a genetic cause in patients with nonisolated CHD. These genetic variants disrupt or alter genes that play an important role in normal cardiac development and in some cases have pleiotropic effects on other organs. This work reviews some of the most common genetic causes of CHD as well as what is currently known about the underlying mechanisms.
Collapse
Affiliation(s)
| | - Wendy K Chung
- Department of Pediatrics.,Department of Medicine, Columbia University Irving Medical Center, New York, New York 10032, USA
| |
Collapse
|
37
|
Awori MN, Awori JA, Mehta NP, Makori O. Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of Fallot: A Meta-Analysis. World J Pediatr Congenit Heart Surg 2020; 11:619-624. [PMID: 32853082 DOI: 10.1177/2150135120934763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Monocusp valves are thought to reduce early operative mortality and morbidity associated with pediatric tetralogy of Fallot repair. As there are no published randomized clinical trials comparing outcomes with and without a monocusp valve, we performed a meta-analysis of observational studies in accordance with established protocols. After systematically searching PubMed, the Cochrane Library, and Google Scholar, 12 studies were included. The operative mortality was compared in 695 patients, and we found no difference between patients with and patients without a monocusp valve. Monocusp valves may not improve operative mortality of tetralogy of Fallot repair in pediatric patients.
Collapse
Affiliation(s)
- Mark N Awori
- Department of Surgery, School of Medicine, 108330University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Jonathan A Awori
- Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Nikita P Mehta
- Department of Surgery, School of Medicine, 108330University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Obed Makori
- Department of Surgery, School of Medicine, 108330University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| |
Collapse
|
38
|
Martins C, Gama BMN. Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
39
|
Derangement of Arginine and Related Amino Acids in Children Undergoing Surgery for Congenital Heart Disease With Cardiopulmonary Bypass. Crit Care Explor 2020; 2:e0150. [PMID: 32766551 PMCID: PMC7368881 DOI: 10.1097/cce.0000000000000150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Supplemental Digital Content is available in the text. Arginine is a conditionally essential amino acid, the precursor for nitric oxide and a key factor in cell proliferation, protein synthesis, and energy metabolism. When there is increased demand in the setting of inflammation, ischemia-reperfusion injury, and organ dysfunction, endogenous arginine production falls short, and external supplementation may be necessary. The goal of this study was to assess changes in concentrations of plasma arginine, citrulline, ornithine, glutamine, and plasma arginase in infants and children undergoing surgery for congenital heart disease with cardiopulmonary bypass.
Collapse
|
40
|
Schunck EDR, Schaan CW, Pereira GA, Rosa NV, Normann TC, Ricachinevsky CP, Reppold CT, Ferrari RS, Lukrafka JL. Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge. Rev Bras Ter Intensiva 2020; 32:261-267. [PMID: 32667453 PMCID: PMC7405751 DOI: 10.5935/0103-507x.20200042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the functional status of pediatric patients undergoing congenital heart surgery after discharge from the intensive care unit, and to evaluate the correlations among clinical variables, functional status and surgical risk. Methods Cross-sectional study including patients aged 1 month to less than 18 years undergoing congenital heart surgery between October 2017 and May 2018. Functional outcome was assessed by the Functional Status Scale, surgical risk classification was determined using the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and clinical variables were collected from electronic medical records. Results The sample comprised 57 patients with a median age of 7 months (2 - 17); 54.4% were male, and 75.5% showed dysfunction, which was moderate in 45.6% of the cases. RACHS-1 category > 3 was observed in 47% of the sample, indicating higher surgical risk. There was a correlation between functional deficit and younger age, longer duration of invasive mechanical ventilation and longer intensive care unit stay. Moreover, greater functional deficit was observed among patients classified as RACHS-1 category > 3. Conclusion The prevalence of functional deficit was high among children and adolescents with congenital heart disease after cardiac surgery. Higher surgical risk, longer duration of invasive mechanical ventilation, longer intensive care unit stay and younger age were correlated with worse functional status.
Collapse
Affiliation(s)
| | - Camila Wohlgemuth Schaan
- Serviço de Fisioterapia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Nathália Vieira Rosa
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Claudia Pires Ricachinevsky
- Unidade de Terapia Intensiva Pediátrica, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Renata Salatti Ferrari
- Serviço de Fisioterapia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | |
Collapse
|
41
|
Toward detection of conduction tissue during cardiac surgery: Light at the end of the tunnel? Heart Rhythm 2020; 17:2200-2207. [PMID: 32659372 DOI: 10.1016/j.hrthm.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
Postoperative conduction block requiring lifetime pacemaker placement continues to be a considerable source of morbidity for patients undergoing repair of congenital heart defects. Damage to the cardiac conduction system (CCS) during surgical procedures is thought to be a major cause of conduction block. Intraoperative identification and avoidance of the CCS is thus a key strategy to improve surgical outcomes. A number of approaches have been developed to avoid conduction tissue damage and mitigate morbidity. Here we review the historical and contemporary approaches for identification of conduction tissue during cardiac surgery. The established approach for intraoperative identification is based on anatomic landmarks established in extensive histologic studies of normal and diseased heart. We focus on landmarks to identify the sinus and atrioventricular nodes during cardiac surgery. We also review technologies explored for intraoperative tissue identification, including electrical impedance measurements and electrocardiography. We describe new optical approaches, in particular, and optical spectroscopy and fiberoptic confocal microscopy (FCM) for identification of CCS regions and working myocardium during surgery. As a template for translation of future technology developments, we describe research and regulatory pathways to translate FCM for cardiac surgery. We suggest that along with more robust approaches to surgeon training, including awareness of fundamental anatomic studies, optical approaches such as FCM show promise in aiding surgeons with repairs of heart defects. In particular, for complex defects, these approaches can complement landmark-based identification of conduction tissue and thus help to avoid injury to the CCS due to surgical procedures.
Collapse
|
42
|
Lomivorotov V, Kornilov I, Boboshko V, Shmyrev V, Bondarenko I, Soynov I, Voytov A, Polyanskih S, Strunin O, Bogachev-Prokophiev A, Landoni G, Nigro Neto C, Oliveira Nicolau G, Saurith Izquierdo L, Nogueira Nascimento V, Wen Z, Renjie H, Haibo Z, Bazylev V, Evdokimov M, Sulejmanov S, Chernogrivov A, Ponomarev D. Effect of Intraoperative Dexamethasone on Major Complications and Mortality Among Infants Undergoing Cardiac Surgery: The DECISION Randomized Clinical Trial. JAMA 2020; 323:2485-2492. [PMID: 32573670 PMCID: PMC7312411 DOI: 10.1001/jama.2020.8133] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Corticosteroids are widely used in pediatric cardiac surgery to blunt systemic inflammatory response and to reduce complications; nevertheless, their clinical efficacy is uncertain. OBJECTIVE To determine whether intraoperative administration of dexamethasone is more effective than placebo for reducing major complications and mortality during pediatric cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS The Intraoperative Dexamethasone in Pediatric Cardiac Surgery was an investigator-initiated, double-blind, multicenter randomized trial that involved 4 centers in China, Brazil, and Russia. A total of 394 infants younger than 12 months, undergoing cardiac surgery with cardiopulmonary bypass were enrolled from December 2015 to October 2018, with follow-up completed in November 2018. INTERVENTIONS The dexamethasone group (n = 194) received 1 mg/kg of dexamethasone; the control group (n = 200) received an equivolume of 0.9% sodium chloride intravenously after anesthesia induction. MAIN OUTCOMES AND MEASURES The primary end point was a composite of death, nonfatal myocardial infarction, need for extracorporeal membrane oxygenation, need for cardiopulmonary resuscitation, acute kidney injury, prolonged mechanical ventilation, or neurological complications within 30 days after surgery. There were 17 secondary end points, including the individual components of the primary end point, and duration of mechanical ventilation, inotropic index, intensive care unit stay, readmission to intensive care unit, and length of hospitalization. RESULTS All of the 394 patients randomized (median age, 6 months; 47.2% boys) completed the trial. The primary end point occurred in 74 patients (38.1%) in the dexamethasone group vs 91 patients (45.5%) in the control group (absolute risk reduction, 7.4%; 95% CI, -0.8% to 15.3%; hazard ratio, 0.82; 95% CI, 0.60 to 1.10; P = .20). Of the 17 prespecified secondary end points, none showed a statistically significant difference between groups. Infections occurred in 4 patients (2.0%) in the dexamethasone group vs 3 patients (1.5%) in the control group. CONCLUSIONS AND RELEVANCE Among infants younger than 12 months undergoing cardiac surgery with cardiopulmonary bypass, intraoperative administration of dexamethasone, compared with placebo, did not significantly reduce major complications and mortality at 30 days. However, the study may have been underpowered to detect a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02615262.
Collapse
Affiliation(s)
- Vladimir Lomivorotov
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
- Novosibirsk State University, Novosibirsk, Russia
| | - Igor Kornilov
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vladimir Boboshko
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vladimir Shmyrev
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Ilya Bondarenko
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Ilya Soynov
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexey Voytov
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | | | - Oleg Strunin
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | | | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | - Zhang Wen
- Shanghai Jiaotong University School of Medicine, Shanghai Children's Medical Center, Shanghai Shi, China
| | - Hu Renjie
- Shanghai Jiaotong University School of Medicine, Shanghai Children's Medical Center, Shanghai Shi, China
| | - Zhang Haibo
- Shanghai Jiaotong University School of Medicine, Shanghai Children's Medical Center, Shanghai Shi, China
| | - Vladlen Bazylev
- Federal Centre of Cardiovascular Surgery, Penza, Russian Federation
| | | | | | | | - Dmitry Ponomarev
- E. N. Meshalkin National Medical Research Center, Novosibirsk, Russia
| |
Collapse
|
43
|
Modestini M, Hoffmann L, Niezen C, Armocida B, Vos JJ, Scheeren TWL. Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study. Can J Anaesth 2020; 67:1170-1181. [PMID: 32557197 PMCID: PMC7299246 DOI: 10.1007/s12630-020-01733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Non-invasive cerebral oxygen saturation (ScO2) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO2 and postoperative outcome by investigating both baseline ScO2 values and intraoperative desaturations from baseline. Methods All CCS procedures performed in the period 2010-2017 in our institution in which ScO2 was monitored were included in this historical cohort study. Baseline ScO2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV), and 30-day mortality. Intraoperatively, ScO2 total time below baseline (TBBL) and ScO2 time-weighted average (TWA) were calculated. Results Data from 565 patients were analyzed. Baseline ScO2 was significantly associated with LOS in ICU (odds ratio [OR] per percentage decrease in baseline ScO2, 0.95; 95% confidence interval [CI], 0.93 to 0.97; P < 0.001), with LOS in hospital (OR, 0.93; 95% CI, 0.91 to 0.96; P < 0.001), with MV duration (OR, 0.92; 95% CI, 0.90 to 0.95; P < 0.001) and with 30-day mortality (OR, 0.94; 95% CI, 0.91 to 0.98; P = 0.007). Cerebral oxygen saturation TWA had no associations, while ScO2 TBBL had only a small association with LOS in ICU (OR, 1.02; 95% CI, 1.01 to 1.03; P < 0.001), MV duration (OR,1.02; 95% CI, 1.01 to 1.03; P = 0.002), and LOS in hospital (OR, 1.02; 95% CI, 1.01 to 1.04; P < 0.001). Conclusion In pediatric patients undergoing cardiac surgery, low baseline ScO2 values measured after tracheal intubation were associated with several adverse postoperative outcomes. In contrast, the severity of actual intraoperative cerebral desaturation was not associated with postoperative outcomes. Baseline ScO2 measured after tracheal intubation may help identify patients at increased perioperative risk.
Collapse
Affiliation(s)
- Marco Modestini
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisa Hoffmann
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Caren Niezen
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benedetta Armocida
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jaap Jan Vos
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW Anesthesia for cardiac surgery has traditionally utilized high-dose opioids to blunt the sympathetic response to surgery. However, recent data suggest that opioids prolong postoperative intubation, leading to increased morbidity. Given the increased risk of opioid dependency after in-hospital exposure to opioids, coupled with an increase in morbidity, regional techniques offer an adjunct for perioperative analgesia. The aim of this review is to describe conventional and emerging regional techniques for cardiac surgery. RECENT FINDINGS Well-studied techniques such as thoracic epidurals and paravertebral blocks are relatively low risk despite lack of widespread adoption. Benefits include reduced opioid exposure after paravertebral blocks and reduced risk of perioperative myocardial infarction after epidurals. To further lower the risk of epidural hematoma and pneumothorax, new regional techniques have been studied, including parasternal, pectoral, and erector spinae plane blocks. Because these are superficial compared with paravertebral and epidural blocks, they may have even lower risks of hematoma formation, whereas patients are anticoagulated on cardiopulmonary bypass. Efficacy data have been promising, although large and generalizable studies are lacking. SUMMARY New regional techniques for cardiac surgery may be potent perioperative analgesic adjuncts, but well-designed studies are needed to quantify the effectiveness and safety of these blocks.
Collapse
|
45
|
Tong Y, Zhang P, Li S, Yan J, Feng Z, Zhao J, Guo S, Jin Y, Liu J. Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery. Artif Organs 2019; 44:40-49. [PMID: 31315148 DOI: 10.1111/aor.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
Simple regional cerebral perfusion (SRCP) or cerebro-myocardial perfusion (CMP) is selectively used in one-stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption-related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110-0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001-1.020), P = .031]. In-hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on-pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.
Collapse
Affiliation(s)
- Yuanyuan Tong
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiyao Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- State Key Laboratory of Cardiovascular Disease, Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Yan
- State Key Laboratory of Cardiovascular Disease, Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyi Feng
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ju Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengwen Guo
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jin
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
46
|
Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study. Cardiol Young 2019; 29:511-518. [PMID: 31107196 DOI: 10.1017/s1047951119000210] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes. METHODS The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100-150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation. RESULTS A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%). CONCLUSIONS Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
Collapse
|
47
|
Predictors of Extended Length of Hospital Stay Following Surgical Repair of Congenital Heart Diseases. Pediatr Cardiol 2018; 39:1688-1699. [PMID: 30171266 DOI: 10.1007/s00246-018-1953-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 01/28/2023]
Abstract
The purpose of this study is to evaluate post-operative length of stay (LOS) following surgical repair of congenital heart defects (CHD) and to investigate baseline pre-operative factors and predictors of post-operative LOS (pLOS). Retrospective chart review of all cases of corrective surgery for CHD performed at the Pediatric Cardiology Unit, King Abdulaziz University Hospital, Jeddah during January 2013-December 2016. Baseline demographics, clinical factors, pre-operative, intra-operative, post-operative cardiac and extra-cardiac complications were analyzed as independent factors of pLOS using stepwise linear regression. Kaplan-Meier (KM) survival analysis was used to analyze the correlation of pLOS (in days) with the independent variables and estimate the probability to exceeding a given pLOS. A total 191 patients (52.4% male, 49.7% aged ≤ 1 year) were included with a median [range] LOS = 10 [3, 158] days. Several baseline clinical factors were associated with longer pLOS such as complex CHD types (tetralogy of Fallot, transposition of great arteries, etc.), high-risk RACHS categories and low weight at surgery. Independent risk factors of pLOS included pre-operative hemoglobin level (unstandardized regression coefficient: B = 2.96, p = 0.036) as the only pre-operative predictor of LOS, besides intra-operative complications (B = 11.72, p = 0.009) and posto-perative factors including MV duration (B = 9.39, p < 0.001), diet/feeding problems (B = 10.27, p = 0.001) and drain tube stay (B = 3.82, p = 0.003). KM survival curves confirmed that these factors increased the probability for longer LOS. Post-operative LOS was associated with several baseline and peri-operative factors; however, it was independently predicted by abnormal baseline hemoglobin level, the occurrence of intra-operative complications, besides post-operative feeding problems, chest drain stay, and MV duration.
Collapse
|
48
|
Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery. Pediatr Crit Care Med 2018; 19:1015-1023. [PMID: 30095748 DOI: 10.1097/pcc.0000000000001694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to validate the Vasoactive-Ventilation-Renal score, a novel disease severity index, as a predictor of outcome in a multicenter cohort of neonates who underwent cardiac surgery. DESIGN Retrospective chart review. SETTING Seven tertiary-care referral centers. PATIENTS Neonates defined as age less than or equal to 30 days at the time of cardiac surgery. INTERVENTIONS Ventilation index, Vasoactive-Inotrope Score, serum lactate, and Vasoactive-Ventilation-Renal score were recorded for three postoperative time points: ICU admission, 6 hours, and 12 hours. Peak values, defined as the highest of the three measurements, were also noted. Vasoactive-Ventilation-Renal was calculated as follows: ventilation index + Vasoactive-Inotrope Score + Δ creatinine (change in creatinine from baseline × 10). Primary outcome was prolonged duration of mechanical ventilation, defined as greater than 96 hours. Receiver operative characteristic curves were generated, and abilities of variables to correctly classify prolonged duration of mechanical ventilation were compared using area under the curve values. Multivariable logistic regression modeling was also performed. MEASUREMENTS AND MAIN RESULTS We reviewed 275 neonates. Median age at surgery was 7 days (25th-75th percentile, 5-12 d), 86 (31%) had single ventricle anatomy, and 183 (67%) were classified as Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Category 4 or 5. Prolonged duration of mechanical ventilation occurred in 89 patients (32%). At each postoperative time point, the area under the curve for prolonged duration of mechanical ventilation was significantly greater for the Vasoactive-Ventilation-Renal score as compared to the ventilation index, Vasoactive-Inotrope Score, and serum lactate, with an area under the curve for peak Vasoactive-Ventilation-Renal score of 0.82 (95% CI, 0.77-0.88). On multivariable analysis, peak Vasoactive-Ventilation-Renal score was independently associated with prolonged duration of mechanical ventilation, odds ratio (per 1 unit increase): 1.08 (95% CI, 1.04-1.12). CONCLUSIONS In this multicenter cohort of neonates who underwent cardiac surgery, the Vasoactive-Ventilation-Renal score was a reliable predictor of postoperative outcome and outperformed more traditional measures of disease complexity and severity.
Collapse
|
49
|
Xia Y, Yang Y, Huang S, Wu Y, Li P, Zhuang J. Clinical application of chromosomal microarray analysis for the prenatal diagnosis of chromosomal abnormalities and copy number variations in fetuses with congenital heart disease. Prenat Diagn 2018; 38:406-413. [PMID: 29573438 DOI: 10.1002/pd.5249] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/17/2018] [Accepted: 03/07/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study aimed to determine chromosomal abnormalities and copy number variations (CNVs) in fetuses with congenital heart disease (CHD) by chromosomal microarray analysis (CMA). METHODS One hundred and ten cases with CHD detected by prenatal echocardiography were enrolled in the study; 27 cases were simple CHDs, and 83 were complex CHDs. Chromosomal microarray analysis was performed on the Affymetrix CytoScan HD platform. All annotated CNVs were validated by quantitative PCR. RESULTS Chromosomal microarray analysis identified 6 cases with chromosomal abnormalities, including 2 cases with trisomy 21, 2 cases with trisomy 18, 1 case with trisomy 13, and 1 unusual case of mosaic trisomy 21. Pathogenic CNVs were detected in 15.5% (17/110) of the fetuses with CHDs, including 13 cases with CHD-associated CNVs. We further identified 10 genes as likely novel CHD candidate genes through gene functional enrichment analysis. We also found that pathogenic CMA results impacted the rate of pregnancy termination. CONCLUSIONS This study shows that CMA is particularly effective for identifying chromosomal abnormalities and CNVs in fetuses with CHDs as well as having an effect on obstetrical outcomes. The elucidation of the genetic basis of CHDs will continue to expand our understanding of the etiology of CHDs.
Collapse
Affiliation(s)
- Yu Xia
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Yongchao Yang
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Shufang Huang
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Yueheng Wu
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Ping Li
- Prenatal Diagnosis Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China.,Department of Obstetrics and Gynecology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery of Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong, China
| |
Collapse
|
50
|
Tan W, Zhang C, Liu J, Li X, Chen Y, Miao Q. Remote Ischemic Preconditioning has a Cardioprotective Effect in Children in the Early Postoperative Phase: A Meta-Analysis of Randomized Controlled Trials. Pediatr Cardiol 2018; 39:617-626. [PMID: 29302715 DOI: 10.1007/s00246-017-1802-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022]
Abstract
In this updated meta-analysis, we assessed the cardioprotective effect of remote ischemic preconditioning (RIPC) in pediatric patients undergoing congenital heart surgery. A total of 9 randomized controlled trials (RCTs) involving 793 pediatric patients under 18 years old were identified. RIPC obviously reduced the release of troponin I at 6 h after surgery [standard mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04; p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0.43, 95% CI -0.72 to -0.14; p = 0.004) and within 12 h (SMD -0.26, 95% CI -0.50 to -0.02; p = 0.03) and shortened the ventilator support time (SMD -0.28, 95% CI -0.49 to -0.07; p = 0.01) as well as the duration of intensive care unit (ICU) stay (SMD -0.21, 95% CI -0.35 to -0.06; p = 0.004). Our meta-analysis determined that RIPC had cardioprotective effects in the early postoperative phase. Additional RCTs focused on the cardiac benefits from RIPC in pediatric patients are warranted.
Collapse
Affiliation(s)
- Wen Tan
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuzhi Chen
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|