Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

Biomarkers, Socioeconomic Factors, and Right Ventricular Function After Surgical Repair for Tetralogy of Fallot

Right ventricular (RV) dysfunction early after tetralogy of Fallot (TOF) increases post-operative morbidity. We investigated associations of circulating biomarkers and socioeconomic factors with early post-operative RV systolic function. Single-center prospective cohort study of infants undergoing TOF repair. Six serologic biomarkers of myocardial fibrosis and wall stress collected at the time of surgery were measured with immunoassay. Geocoding was performed for socioeconomic factors. Multivariate adaptive regression splines (MARS) models identified factors associated with RV function parameters: fractional area change (FAC), global longitudinal strain and strain rate, and free wall strain and strain rate. Seventy-one patients aged 3.5 months (IQR 2.4, 5.2) were included. Galectin-3 was the highest ranked predictor for FAC, global longitudinal strain, and free wall strain, and procollagen type-I carboxy-terminal propeptide (PICP) was the highest ranked predictor for global longitudinal strain rate and free wall strain rate. Several neighborhood characteristics were also highly ranked. Models adjusted R² ranged from 0.71 to 0.85 (FAC, global longitudinal strain/strain rate), and 0.55-0.57 (RV free wall strain/strain rate). A combination of serologic biomarkers, socioeconomic, and clinical variables explain a significant proportion of the variability in RV function after TOF repair. These factors may inform pre-operative risk-stratification for these patients.

Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Objectives: To evaluate the predictive value of the pulmonary vein index (PVI) in the early prognosis of patients who received total tetralogy of Fallot (TOF) repair. Methods: We retrospectively reviewed 286 patients who underwent TOF repair in our institution between July 2013 and May 2020. The PVI, McGoon ratio, and Nakata index were measured and calculated. Logistic regression, linear stepwise regression, receiver operating characteristic (ROC) curve analysis, and Cox proportional hazards modeling were performed to evaluate the predictive value of PVI in the early prognosis after TOF repair surgery. Results: The median age and body weight were 1.23 (0.22-15.02) years and 9.00 (3.00-44.00) kg, respectively. There were five early deaths. The areas under the ROC curve for death were 0.89, 0.79, and 0.88 for the McGoon ratio, Nakata index, and PVI, respectively. A lower PVI better predicted prolonged postoperative hospital stay, cardiac intensive care unit stay, and ventilator time (Hazard Ratio, HR [95% Confidence intervals, CI]: 1.003 [1.002-1.004], p < 0.001; 1.002 [1.001-1.004], p < 0.001; 1.002 [1.001-1.003], p < 0.001, respectively) and was a significant risk factor for high 24 h max Vasoactive inotropic score (Crude Odds Ratio [OR] [95% CI]: -0.015 [-0.022, -0.007], p < 0.001), serous effusion (Crude OR [95% CI]: 0.996 [0.992-0.999], p = 0.020), delayed sternal closure (Crude OR [95% CI]: 0.983 [0.971-0.996], p = 0.010), and the need for peritoneal dialysis (Crude OR [95% CI]: 0.988 [0.980-0.996], p = 0.005). The area under the ROC curve of PVI for delayed postoperative recovery was 0.722 (p < 0.001), and the estimated cutoff point was 300.3 mm²/m². Conclusion: PVI is a good predictor of early prognosis for surgical treatment of TOF patients.

Predictors of Prolonged Mechanical Ventilation in Pediatric Patients After Cardiac Surgery for Congenital Heart Disease

Background

The duration of mechanical ventilation (MV) is one of the most important clinical factors which predict outcomes in pediatric cardiac surgery. The prolonged mechanical ventilation (PMV) following cardiac surgery is a multifactorial phenomenon and there are conflicts regarding its predictors in pediatric population between different centers.

Objectives

The current study aimed to describe PMV predictors in patients undergoing cardiac surgery for congenital heart disease in a tertiary center for pediatric cardiovascular diseases in Iran.

Patients and Methods

From May to December 2014, all pediatric patients (less than a month – 15 years old) admitted to pediatric Intensive Care Unit (PICU) after congenital heart surgeries were consecutively included. The PMV was defined as mechanical ventilation duration more than 72 hours as medium PMV and more than seven days as extended PMV. The demographic data and variables probably related to PMV were recorded during the PICU stay.

Results

A total of 300 patients, 56.7% male, were enrolled in this study. Their mean age was 32 ± 40 months .The median duration (IQR) of MV was 18 hours (8.6 - 48 hours). The incidence of PMV more than 72 hours and seven days was 20% and 10.7%, respectively. Younger age, lower weight, heart failure, higher doses of inotropes, pulmonary hypertension, respiratory infections and delayed sternal closure were independent predictors of PMV in multivariate analyses.

Conclusions

The results of this study indicated that PMV predictors could be specific for each center and a good administration program is needed for each pediatric cardiac surgery center for the preoperative management of patients undergoing congenital heart surgeries.