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Rahmath MRK, Bhat AN, Lone RA, Kamal RY. Efficacy of nil per oral, total parenteral nutrition, milrinone and non-suction chest tube drainage-based management for chylothorax following pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 2024:2184923241249198. [PMID: 38659299 DOI: 10.1177/02184923241249198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE A single centre experience with chylothorax in post cardiac surgical patients. METHODS Retrospective review. RESULTS Chylothorax developed in 55 out of 873 operated patients (6.3%). Median age of the chylothorax cohort was 95 days (range 1-995). Neonates constituted 36% and 49% were infants. Group-1(35 patients-treated during the years 2011-2015) included those who were managed with low fat diet initially with other standard measures including steroid, octreotide, pleurodesis, lymphangiogram or thoracic duct ligation whenever required.Group-2 (20 patients, treated between year 2016-2018) were managed with nil per oral, total parenteral nutrition, extended use of milrinone and no use of chest tube suction with other above standard measures when required.Group-1 and group-2 were comparable in terms of their age and weight (p > 0.05).We observed lower volume of chest drainage, shorter intubation time, length of intensive care stay and hospital stay in group-2 compared to group-1 though they were statistically not significant (p > 0.05). Occurrence of massive chylothorax (>20 ml/kg/day) in group-1 was significantly higher [18 patients (51%) in group-1 vs 4 patients in group-2 (20%) (Chi-square 5.25, p = 0.02)]. In hospital mortality in group-1 was higher compared to group-2 (5/35 = 14.5% vs 1/20 = 5%), however, it was statistically not significant [risk ratio 2.86; 95% CI 0.36, 22.77; p = 0.59)]. Acute kidney injury was observed in about 25% of patients who had chylothorax. A higher mortality was observed in patients with chylothorax who had acute kidney injury [5/14 (35%)] compared to those who did not have acute kidney injury [1/41 (2.4%)] (Chi-square 11.89, p = 0.001)]. SUMMARY In a heterogenous cohort of post-cardiac surgical patients who developed chylothorax, our suggested new regime (nil per oral, parenteral nutrition, extended use of milrinone and no suction applied to the chest drains) contributed to reduce the frequency of massive chylothorax occurrence significantly.
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Affiliation(s)
| | - Akhlaque N Bhat
- Pediatric Cardiac Surgery Division, CT Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Reyaz A Lone
- Pediatric Cardiac Surgery Division, CT Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Reema Y Kamal
- Pediatric Cardiology, Pediatrics, Hamad Medical Corporation, Doha, Qatar
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Muenster S, Zarragoikoetxea I, Moscatelli A, Balcells J, Gaudard P, Pouard P, Marczin N, Janssens SP. Inhaled NO at a crossroads in cardiac surgery: current need to improve mechanistic understanding, clinical trial design and scientific evidence. Front Cardiovasc Med 2024; 11:1374635. [PMID: 38646153 PMCID: PMC11027901 DOI: 10.3389/fcvm.2024.1374635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024] Open
Abstract
Inhaled nitric oxide (NO) has been used in pediatric and adult perioperative cardiac intensive care for over three decades. NO is a cellular signaling molecule that induces smooth muscle relaxation in the mammalian vasculature. Inhaled NO has the unique ability to exert its vasodilatory effects in the pulmonary vasculature without any hypotensive side-effects in the systemic circulation. In patients undergoing cardiac surgery, NO has been reported in numerous studies to exert beneficial effects on acutely lowering pulmonary artery pressure and reversing right ventricular dysfunction and/or failure. Yet, various investigations failed to demonstrate significant differences in long-term clinical outcomes. The authors, serving as an advisory board of international experts in the field of inhaled NO within pediatric and adult cardiac surgery, will discuss how the existing scientific evidence can be further improved. We will summarize the basic mechanisms underlying the clinical applications of inhaled NO and how this translates into the mandate for inhaled NO in cardiac surgery. We will move on to the popular use of inhaled NO and will talk about the evidence base of the use of this selective pulmonary vasodilator. This review will elucidate what kind of clinical and biological barriers and gaps in knowledge need to be solved and how this has impacted in the development of clinical trials. The authors will elaborate on how the optimization of inhaled NO therapy, the development of biomarkers to identify the target population and the definition of response can improve the design of future large clinical trials. We will explain why it is mandatory to gain an international consensus for the state of the art of NO therapy far beyond this expert advisory board by including the different major players in the field, such as the different medical societies and the pharma industry to improve our understanding of the real-life effects of inhaled NO in large scale observational studies. The design for future innovative randomized controlled trials on inhaled NO therapy in cardiac surgery, adequately powered and based on enhanced biological phenotyping, will be crucial to eventually provide scientific evidence of its clinical efficacy beyond its beneficial hemodynamic properties.
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Affiliation(s)
- Stefan Muenster
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Iratxe Zarragoikoetxea
- Department of Anesthesiology and Intensive Care Medicine, Hospital Universitari I Politècnic Fe, Valencia, Spain
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Joan Balcells
- Pediatric Intensive Care Unit, Vall d’Hebron Barcelona Campus Hospitalari, Universitari Vall d'Hebron, Barcelona, Spain
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine Arnaud de Villeneuve, CHU Montpellier, University of Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Philippe Pouard
- Department of Anesthesiology and Critical Care, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - Nandor Marczin
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Stefan P. Janssens
- Cardiac Intensive Care, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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Somani S, Makhija N, Chauhan S, Bhoi D, Das S, Bandi SG, Rajashekar P, Bisoi AK. Comparison of Multiple Injection Costotransverse Block and Erector Spinae Plane Block for Post-Sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Randomized Comparative Study. J Cardiothorac Vasc Anesth 2024; 38:974-981. [PMID: 38326195 DOI: 10.1053/j.jvca.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of ultrasound-guided multiple injection costotransverse block (MICB) and compare it with erector spinae plane block (ESPB) for poststernotomy pain relief in pediatric cardiac surgical patients. DESIGN A prospective, randomized, double-blind, comparative study. SETTING At a single institution tertiary referral cardiac center. PARTICIPANTS A total of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy. INTERVENTIONS Children were allocated randomly to 1 of the 3 following groups: ESPB (group 1), MICB (group 2), or Control (group 3). Participants in groups 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl/tramadol was used for rescue analgesia. MEASUREMENTS AND MAIN RESULTS The modified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours postextubation. After all exclusions, 84 patients were analyzed. The MOPS score was found to be significantly lower in ESPB and MICB groups compared to the control group until 10 hours postextubation (p < 0.05), with no statistically significant difference at the 12th hour (p = 0.2198). The total intraoperative fentanyl consumption (p = 0.0005), need for fentanyl supplementation on incision (p < 0.0001), and need for rescue opioid requirement in the postoperative period (p = 0.034) were significantly lower in both the ESPB and MICB groups than the control group. There were no statistically significant differences in both primary and secondary outcomes between the ESPB and MICB groups. CONCLUSION Ultrasound-guided MICB was effective and comparable to ESPB for post-sternotomy pain management in pediatric cardiac surgical patients.
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Affiliation(s)
- Shruti Somani
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Sandeep Chauhan
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sambhunath Das
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sushama Gayatri Bandi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Akshya Kumar Bisoi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Bhende VV, Sharma TS, Krishnakumar M, Ramaswamy AS, Bilgi K, Pathan SR. Beyond Synthetics: Promising Outcomes With the Invengenx® Bovine Pericardial Patch for Ventricular Septal Defect Repair in a Young Pediatric Population. Cureus 2024; 16:e55530. [PMID: 38444930 PMCID: PMC10913133 DOI: 10.7759/cureus.55530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
Ventricular septal defects (VSDs) are a prevalent congenital heart anomaly demanding safe and lasting interventions. This paper explores the application of Invengenx® bovine pericardial patch (Tisgenx, Irvine, California), a promising biomaterial, in VSD repair. We present two case studies: a seven-month-old infant and a three-year-old child undergoing VSD closure using autologous and bovine pericardial patches, respectively. Both patients tolerated the procedures well, experiencing no intra-operative complications and demonstrating excellent postoperative recovery. Echocardiography postoperatively showed no complications and improved clinical outcomes. Notably, the pericardial patches exhibited excellent integration and suture retention, highlighting their durability and compatibility with the growing heart. These cases establish the feasibility and effectiveness of the Invengenx® pericardial patch for VSD repair. The favorable outcomes in terms of safety and efficacy support the potential of this biomaterial as a valuable alternative in pediatric cardiac surgery, particularly for complex VSDs or patients with contraindications to synthetic patches. Further research is crucial to unlock the full potential of bovine pericardium as a durable and advantageous option for VSD repair in a broader range of pediatric patients.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | | | - Anikode S Ramaswamy
- Pathology, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Kanchan Bilgi
- Neuroanesthesiology, People Tree Hospitals, Bengaluru, IND
| | - Sohilkhan R Pathan
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
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Nakata T, Tachi M, Yasuda K, Nakashima S, Ikeda T, Minatoya K, Oda T. Pleurodesis using OK-432 for persistent pleural effusion after cardiac surgery in the neonatal period or early infancy. Asian Cardiovasc Thorac Ann 2024; 32:83-90. [PMID: 38073052 DOI: 10.1177/02184923231219606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate the efficacy of pleurodesis using OK-432 after cardiac surgery in the neonatal period or early infancy. METHODS We retrospectively reviewed the data of 11 consecutive patients who underwent cardiac surgery in the neonatal period or early infancy and pleurodesis using OK-432 for persistent postoperative pleural effusion in two institutions. RESULTS The median age at surgery was 8 days (interquartile range [IR], 2-18) with a body weight of 2.84 kg (IR, 2.30-3.07). The maximum amount of pleural drainage before pleurodesis was 94.7 (IR, 60.2-107.7) ml/kg/day. Pleurodesis was initiated at postoperative day 20 (IR, 17-22) and performed in bilateral pleural spaces in seven patients and unilateral in four. The median numbers of injection were 4 (IR, 3-6) times per patient and 3 (IR, 2-3) times per pleural space. In 10 patients, pleural effusion was decreased effectively, and drainage tubes were removed without reaccumulation within 15 (IR, 12-28) days after initial pleurodesis. However, in one patient, with severe lymphedema, pleural effusion was uncontrollable, resulting in death due to sepsis. Adverse events were observed in nine patients; temporal deterioration of lung compliance and arterial blood gas occurred in two, insufficient drainage requiring new chest tube(s) in five, temporal atrial tachyarrhythmia in one, and lymphedema in four. CONCLUSIONS Pleurodesis using OK-432 is effective and reliable for persistent postoperative pleural effusion in neonates and early infants. Most of the complications, which derived from inflammatory reactions, were temporary and controllable. However, severe lymphedema is difficult to control.
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Affiliation(s)
- Tomohiro Nakata
- Departmet of Cardiovascular Surgery, Shimane University Faculty of Medicine, Matsue, Japan
| | - Maiko Tachi
- Departmet of Cardiovascular Surgery, Shimane University Faculty of Medicine, Matsue, Japan
| | - Kenji Yasuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Matsue, Japan
| | - Shigeki Nakashima
- Department of Pediatrics, Shimane University Faculty of Medicine, Matsue, Japan
| | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Kyoto, Japan
| | - Teiji Oda
- Departmet of Cardiovascular Surgery, Shimane University Faculty of Medicine, Matsue, Japan
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Huynh E, Chernick R, Desai M. Francis Fontan (1929-2018): Pioneer pediatric cardiac surgeon. J Med Biogr 2024; 32:110-118. [PMID: 36069037 DOI: 10.1177/09677720221123322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Up until the mid-1900s, tricuspid atresia - a birth defect of the tricuspid valve, was once categorized as a "death sentence." The challenge of achieving positive health outcomes for affected patients was compounded by a hesitancy to operate on children. The main concern was safely administering anesthesia to young patients who were going through a strenuous operation that was often poorly tolerated. Despite these assumed limitations, Francis Fontan, a pediatric cardiothoracic surgeon at the Hospital of Tondu in Bordeaux, was able to redirect blood flow from the superior and inferior vena cava to the pulmonary arteries in 1971, which elucidated the process of advancing clinical practice in medicine. With the support of mentors and a firm belief in this new technique, Fontan pioneered his eponymous procedure and ultimately paved the way for modern cardiovascular surgical techniques that helped to prolong the life of those with single functioning ventricles. The aim of this study is to examine the genesis and the evolution of the Fontan procedure to elucidate the process of advancing clinical practice in medicine by utilizing personal interviews, Fontan's works, associated primary and secondary sources in the context of 20th century cardiothoracic surgery and innovations.
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Affiliation(s)
| | | | - Manisha Desai
- Department of Anesthesiology and Perioperative Medicine, UMass Chan Medical School, Worcester, MA, USA
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AlAshgar TM, AlDawsari NH, AlSanea NY, AlSalamah NA, AlSugair NS, Ardah HI, Kabbani MS. The Outcomes of Cardiac Surgery in Children With DiGeorge Syndrome in a Single Center Experience: A Retrospective Cohort Study. Cureus 2024; 16:e55186. [PMID: 38562270 PMCID: PMC10983060 DOI: 10.7759/cureus.55186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background DiGeorge syndrome, a common genetic microdeletion syndrome, is associated with multiple congenital anomalies, including congenital cardiac diseases. This study aims to identify the short and midterm outcomes of cardiac surgery performed on children with DiGeorge syndrome. Methods A retrospective cohort study was conducted between the period of 2018-2022, which included children divided into two groups with a 1:2 ratio. Group one included DiGeorge syndrome patients who were diagnosed using fluorescence in situ hybridization (FISH). Group two included the control group of patients who were clear of genetic syndromes. The two groups were matched based on similar cardiac surgery, age of surgery, and Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The two groups were compared based on the demographical data and postoperative complications. Results The study consisted of 81 children; 27 were DiGeorge syndrome patients, and 54 were in the control group. DiGeorge syndrome patients showed an increase in mechanical ventilation duration (p=0.0047), intensive care unit (ICU) length of stay (p=0.0012), and hospital length of stay (p=0.0391). Moreover, they showed an increased risk for bacteremia (p=0.0414), ventilator-associated pneumonia (VAP; p=0.0036), urinary tract infections (UTI; p=0.0064), and surgical site infection (SSI; p≤0.0001). They were also more susceptible to postoperative seizures (p=0.0049). Furthermore, patients with DiGeorge syndrome had a higher prevalence of congenital renal anomalies. However, there was no mortality in either group. Conclusion This study shows a variability in the postoperative outcomes between the two groups. The study demonstrates that patients with DiGeorge syndrome have higher risks of infections and longer hospital stay during the postoperative period. Further research with a larger sample is needed to confirm our findings.
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Affiliation(s)
- Tala M AlAshgar
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Norah H AlDawsari
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Nasreen Y AlSanea
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Noura A AlSalamah
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Nada S AlSugair
- Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Husam I Ardah
- Biostatistics and Epidemiology, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Mohamed S Kabbani
- Pediatric Critical Care, Department of Cardiac Sciences, Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Lücht J, Seiler R, Herre AL, Brankova L, Fritsche-Guenther R, Kirwan J, Huscher D, Münzfeld H, Berger F, Photiadis J, Tong G, Schmitt KRL. Promising results of a clinical feasibility study: CIRBP as a potential biomarker in pediatric cardiac surgery. Front Cardiovasc Med 2024; 11:1247472. [PMID: 38361581 PMCID: PMC10867162 DOI: 10.3389/fcvm.2024.1247472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Objective Cold-inducible RNA binding Protein (CIRBP) has been shown to be a potent inflammatory mediator and could serve as a novel biomarker for inflammation. Systemic inflammatory response syndrome (SIRS) and capillary leak syndrome (CLS) are frequent complications after pediatric cardiac surgery increasing morbidity, therefore early diagnosis and therapy is crucial. As CIRBP serum levels have not been analyzed in a pediatric population, we conducted a clinical feasibility establishing a customized magnetic bead panel analyzing CIRBP in pediatric patients undergoing cardiac surgery. Methods A prospective hypothesis generating observational clinical study was conducted at the German Heart Center Berlin during a period of 9 months starting in May 2020 (DRKS00020885, https://drks.de/search/de/trial/DRKS00020885). Serum samples were obtained before the cardiac operation, upon arrival at the pediatric intensive care unit, 6 and 24 h after the operation in patients up to 18 years of age with congenital heart disease (CHD). Customized multiplex magnetic bead-based immunoassay panels were developed to analyze CIRBP, Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10), Monocyte chemotactic protein 1 (MCP-1), Syndecan-1 (SDC-1), Thrombomodulin (TM), Vascular endothelial growth factor (VEGF-A), Angiopoietin-2 (Ang-2), and Fibroblast growth factor 23 (FGF-23) in 25 µl serum using the Luminex MagPix® system. Results 19 patients representing a broad range of CHD (10 male patients, median age 2 years, 9 female patients, median age 3 years) were included in the feasibility study. CIRBP was detectable in the whole patient cohort. Relative to individual baseline values, CIRBP concentrations increased 6 h after operation and returned to baseline levels over time. IL-6, IL-8, IL-10, and MCP-1 concentrations were significantly increased after operation and except for MCP-1 concentrations stayed upregulated over time. SDC-1, TM, Ang-2, as well as FGF-23 concentrations were also significantly increased, whereas VEGF-A concentration was significantly decreased after surgery. Discussion Using customized magnetic bead panels, we were able to detect CIRBP in a minimal serum volume (25 µl) in all enrolled patients. To our knowledge this is the first clinical study to assess CIRBP serum concentrations in a pediatric population.
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Affiliation(s)
- Jana Lücht
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Raphael Seiler
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Alexa Leona Herre
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Liliya Brankova
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Raphaela Fritsche-Guenther
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna Münzfeld
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Giang Tong
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Katharina R. L. Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
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Bhende VV, Sharma TS, Krishnakumar M, Ganjiwale JD, Ramaswamy AS, Bilgi K, Pathan SR. Statistics in the Operating Room: A Cardiovascular Surgeon's Guide to Numbers That Matter. Cureus 2024; 16:e54151. [PMID: 38357411 PMCID: PMC10864814 DOI: 10.7759/cureus.54151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 02/16/2024] Open
Abstract
Pediatric cardiac surgery demands meticulous technique, but optimal outcomes hinge on translating data into actionable insights. This editorial bridges the gap between scalpel and statistical jargon, empowering surgeons to decipher common tests. Descriptive statistics paint portraits of patient cohorts, while hypothesis testing discerns real differences from chance. Regression analysis unveils hidden relationships, predicting outcomes based on complex interplays of variables. Survival analysis tracks the delicate dance of time and survival, informing therapeutic strategies. By embracing statistical fluency, surgeons become architects of personalized care, tailoring interventions to mitigate risks and maximize the precious gift of a beating heart.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
- Community Medicine, SAL Institute of Medical Sciences, Ahmedabad, IND
| | | | - Jaishree D Ganjiwale
- Biostatistics and Epidemiology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, IND
| | | | - Kanchan Bilgi
- Neuroanesthesiology, People Tree Hospitals, Bengaluru, IND
| | - Sohilkhan R Pathan
- Clinical Research, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
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Vanderlaan RD. Improving Outcomes in Pulmonary Vein Stenosis: Novel Pursuits and Paradigm Shifts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2024; 27:92-99. [PMID: 38522879 DOI: 10.1053/j.pcsu.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
Pulmonary vein stenosis (PVS) remains a clinical challenge, with progressive restenosis being common. In the past five years, we have seen an exponential increase in both clinical and scientific publication related to PVS. Central to progress in PVS clinical care is the paradigm shift towards collaborative, multidisciplinary care that utilizes a multimodality approach to treatment. This manuscript will discuss recent conceptual gains in PVS treatment and research while highlighting important outstanding questions and barriers.
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Affiliation(s)
- Rachel D Vanderlaan
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
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Karsenty C, Hadeed K, Pyra P, Guitarte A, Djeddai C, Vincent R, Dulac Y, Silagdze I, Gobin J, Combes N, Ratsimandresy M, Berthomieu L, Calvaruso D, Acar P. Advancing paediatric cardiac imaging: a comprehensive analysis of the feasibility and accuracy of a novel 3D paediatric transoesophageal probe. Front Cardiovasc Med 2023; 10:1294109. [PMID: 38116539 PMCID: PMC10728472 DOI: 10.3389/fcvm.2023.1294109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Aims Pediatric transoesophageal echocardiography (TOE) probes have remained two-dimensional (2D) limiting their use compared to adults. While critical in pediatrics for interventions and post-surgery assessments, technological advancements introduced a three-dimensional (3D) pediatric TOE probe. This study assessed the new 3D pediatric TOE probe (GE 9VT-D) for feasibility, handling, and imaging quality. Methods and results At Children's Hospital of Toulouse, 2-month prospective study enrolled children undergoing TOE with the new probe. All imaging modalities were rated by 2 operators using a 5-point Likert-type scale from 1 (very poor) to 5 (very good) quality. Forty-five children, median age 3.7 (range: 2 months-14.7 years) median weight 7.8 kg (range: 4.3-48 kg) underwent 60 TOEs: 25% pre-surgery, 45% post-surgery, 28% during percutaneous procedures, and 2% in intensive care. Probe handling was "very easy" in all cases without adverse events. The median score of 2D, 2D colour, pulsed Doppler and 3D were noted 5 out of 5 and continuous Doppler and 3D colour 4 out of 5. The 3D image quality remained consistent irrespective of the patient weighing above or below 7.8 kg (p = 0.72). Postoperative TOEs identified two cases needing further interventions, emphasizing its value in evaluating surgical outcomes and also for guiding percutaneous interventions. Conclusion Our comprehensive evaluation demonstrates that the new 3D pediatric TOE probe is feasible and provides high-quality imaging in pediatric patients. The successful integration of this novel probe into clinical practice has the potential to enhance diagnostic accuracy and procedural planning, ultimately optimizing patient outcomes in pediatric cardiac care.
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Affiliation(s)
- Clément Karsenty
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
- Institut Des Maladies Métaboliques Et Cardiovasculaires [Institute of Metabolic and Cardiovascular Diseases], University of Toulouse, Toulouse, France
| | - Khaled Hadeed
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Pierrick Pyra
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Aitor Guitarte
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Camelia Djeddai
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Remi Vincent
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Yves Dulac
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Ia Silagdze
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Julie Gobin
- Department of Anesthesiology and Paediatric Cardiology, University Hospital, Toulouse, France
| | - Nicolas Combes
- Department of Cardiology, Clinique Pasteur [Pasteur Clinic], Toulouse, France
| | | | - Lionel Berthomieu
- Department of Intensive Care Unit and Paediatric Cardiology, University Hospital, Toulouse, France
| | - Davide Calvaruso
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
| | - Philippe Acar
- Department of Paediatric Cardiology, University Hospital, Toulouse, France
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Asfari A, Wolovits J, Gazit AZ, Abbas Q, Macfadyen AJ, Cooper DS, Futterman C, Penk JS, Kelly RB, Salvin JW, Borasino S, Zaccagni HJ. A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients. Crit Care Explor 2023; 5:e1013. [PMID: 38053749 PMCID: PMC10695536 DOI: 10.1097/cce.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Postoperative pediatric congenital heart patients are predisposed to develop low-cardiac output syndrome. Serum lactate (lactic acid [LA]) is a well-defined marker of inadequate systemic oxygen delivery. OBJECTIVES We hypothesized that a near real-time risk index calculated by a noninvasive predictive analytics algorithm predicts elevated LA in pediatric patients admitted to a cardiac ICU (CICU). DERIVATION COHORT Ten tertiary CICUs in the United States and Pakistan. VALIDATION COHORT Retrospective observational study performed to validate a hyperlactatemia (HLA) index using T3 platform data (Etiometry, Boston, MA) from pediatric patients less than or equal to 12 years of age admitted to CICU (n = 3,496) from January 1, 2018, to December 31, 2020. Patients lacking required data for module or LA measurements were excluded. PREDICTION MODEL Physiologic algorithm used to calculate an HLA index that incorporates physiologic data from patients in a CICU. The algorithm uses Bayes' theorem to interpret newly acquired data in a near real-time manner given its own previous assessment of the physiologic state of the patient. RESULTS A total of 58,168 LA measurements were obtained from 3,496 patients included in a validation dataset. HLA was defined as LA level greater than 4 mmol/L. Using receiver operating characteristic analysis and a complete dataset, the HLA index predicted HLA with high sensitivity and specificity (area under the curve 0.95). As the index value increased, the likelihood of having higher LA increased (p < 0.01). In the validation dataset, the relative risk of having LA greater than 4 mmol/L when the HLA index is less than 1 is 0.07 (95% CI: 0.06-0.08), and the relative risk of having LA less than 4 mmol/L when the HLA index greater than 99 is 0.13 (95% CI, 0.12-0.14). CONCLUSIONS These results validate the capacity of the HLA index. This novel index can provide a noninvasive prediction of elevated LA. The HLA index showed strong positive association with elevated LA levels, potentially providing bedside clinicians with an early, noninvasive warning of impaired cardiac output and oxygen delivery. Prospective studies are required to analyze the effect of this index on clinical decision-making and outcomes in pediatric population.
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Affiliation(s)
- Ahmed Asfari
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Wolovits
- Division of Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Avihu Z Gazit
- Divisions of Critical Care and Cardiology, Department of Pediatrics, Washington University, St. Louis, MO
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Andrew J Macfadyen
- Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| | - David S Cooper
- Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Craig Futterman
- Division of Critical Care, Department of Pediatrics, George Washington University, Washington, DC
| | - Jamie S Penk
- Division of Cardiology, Department of Pediatrics, Northwestern University, Chicago, IL
| | - Robert B Kelly
- Division of Critical Care, Children's Hospital of Orange County, Orange, CA
- Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA
| | - Joshua W Salvin
- Division of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Santiago Borasino
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Hayden J Zaccagni
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
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Puzanov A, Tkachuk V, Maksymenko A. Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact - a retrospective single-center study. Ren Fail 2023; 45:2167661. [PMID: 36692196 PMCID: PMC9879166 DOI: 10.1080/0886022x.2023.2167661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA). METHODS Retrospective review of medical data of children who underwent ASO in 2019-2020 in the Ukrainian Children's Cardiac Center. RESULTS 76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 - had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61-127) versus 73.5 (53-136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 - 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 - 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis. CONCLUSIONS In our study, 51.7% of patients developed AKI after ASO, 25.8%-severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score.
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Affiliation(s)
- Anton Puzanov
- Ukrainian Children’s Cardiac Center, Kyiv, Ukraine,CONTACT Anton Puzanov Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
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14
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Gerlach J, Decker ES, Plank AC, Mestermann S, Purbojo A, Cesnjevar RA, Kratz O, Eichler A. Long-Term Effects of Child Early Surgical Ventricular Septal Defect Repair on Maternal Stress. Children (Basel) 2023; 10:1832. [PMID: 38136034 PMCID: PMC10741485 DOI: 10.3390/children10121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023]
Abstract
The ventricular septal defect (VSD) represents the most common congenital heart defect (CHD). The diagnosis of and cardiac surgery for their child's VSD are highly stressful experiences for parents; especially mothers, who are at risk of developing long-lasting stress-related symptoms. This study examined long-term alterations in maternal stress including self-reported psychological and biophysiological stress levels in a case-control design. We investigated 24 mothers of children with an isolated, surgically corrected VSD compared to non-affected controls. Maternal self-reports on psychopathology, everyday stress, parenting stress and hair cortisol concentrations (HCC) were measured during children's primary school age (6-9 years, t1) and early adolescence (10-14 years, t2). In maternal self-reports, psychopathology and stress symptoms in the VSD-group and controls were comparable at t1, whereas at t2, mothers in the VSD-group even showed a decrease in psychopathology. Maternal HCC levels in the VSD-group were significantly lower (hypocortisolism) than HCC levels of controls at t1. This effect was no longer observed at t2 reflecting an approximation of HCC levels in the VSD-group to controls' levels. This study highlights the potential for improved stress hormone balance and psychological well-being in mothers following their child's surgical VSD repair. However, the need for parent-centered interventions is discussed, particularly during peri-operative phases and in early child developmental stages.
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Affiliation(s)
- Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Elena S. Decker
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anne-Christine Plank
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Robert A. Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Department of Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital, 8032 Zürich, Switzerland
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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15
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Hirai N, Saito J, Nakai K, Noguchi S, Hashiba E, Hirota K. Association between regional oxygen saturation and central venous saturation in pediatric patients undergoing cardiac surgery: A prospective observational study. Paediatr Anaesth 2023; 33:913-922. [PMID: 37534800 DOI: 10.1111/pan.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND We evaluated the correlation between regional oxygen saturation (rSO2 ) in the frontal and right renal dorsum (cerebral rSO2 and somatic rSO2 ) measured by near-infrared spectroscopy (INVOS™ 5100C, Medtronic) and central venous oxygen saturation (ScvO2 ) measured with a fiber-optic oximetry catheter (PediaSat™, Edwards Lifesciences) during surgery in order to determine whether noninvasive rSO2 could be used as an alternative to ScvO2 in pediatric cardiac surgery patients. We evaluated the correlation between regional tissue oxygen saturation (cerebral rSO2 and somatic rSO2 ) measured by near-infrared spectroscopy and other patient measures with central venous oxygen saturation (ScvO2 ) measured with a fiber-optic oximetry catheter to track global oxygen supply demand as a potential alternative or supplement to ScvO2 . PATIENTS AND METHODS This single-center prospective observational study enrolled 33 children (weight < 10 kg) who underwent cardiac surgery for congenital heart disease between February 2018 and November 2021. ScvO2 , cerebral rSO2 , and somatic rSO2 were recorded simultaneously after anesthesia induction and central venous catheter placement. Pearson's correlation coefficient and Bland-Altman analysis were used to determine the relationship between ScvO2 and rSO2 . We conducted correlation, Bland Altman, and multiple regression analyses to identify associations between rSO2 , patient measures, and ScvO2 values. RESULTS The patients' median age was 11.0 (quartile 2.0-16.0) months. Their weight was 7.2 (quartile 4.5-9.2) kg. Cerebral rSO2 was significantly positively correlated with ScvO2 (r2 = 0.29, p = .002 in all patients; r2 = 0.61, p = .013 in the patients without mixing at the atrial level), whereas somatic rSO2 was not. The Bland-Altman analysis demonstrated biases [95% confidence interval; 95% CI] (lower and upper limits of agreement [95% CI]) of 0.27% [-4.26 to 4.80] (-24.79 [-32.61 to -16.96] to 25.33 [17.50 to 33.16]) between cerebral rSO2 and ScvO2 and 0.91% [-5.48 to 7.30] (-34.43 [-45.47 to -23.39] to 36.25 [25.21 to 47.29]) between somatic rSO2 and ScvO2 . Preoperative brain natriuretic peptide (BNP) and SpO2 were independent variables associated with ScvO2 and cerebral and somatic rSO2 . CONCLUSION Cerebral rSO2 , SpO2 , and BNP were significantly correlated with ScvO2 , although the cerebral rSO2 correlation was greater for lesions without atrial mixing. rSO2 , BNP, and SpO2 might be used to track changes in ScvO2 but cerebral rSO2 is not sufficiently precise to replace it.
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Affiliation(s)
- Naoki Hirai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kishiko Nakai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoko Noguchi
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care Unit, Hirosaki University Hospital, Hirosaki, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Perioperative Medicine for Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Perioperative Stress Management, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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16
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Kwon JH, Atteya M, Mitta A, Vogel AD, Norris RA, Rajab TK. Ischemia-Reperfusion Injury in Porcine Aortic Valvular Endothelial and Interstitial Cells. J Cardiovasc Dev Dis 2023; 10:436. [PMID: 37887883 PMCID: PMC10607149 DOI: 10.3390/jcdd10100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Ischemia-reperfusion injury (IRI) in the myocardium has been thoroughly researched, especially in acute coronary syndrome and heart transplantation. However, our understanding of IRI implications on cardiac valves is still developing. This knowledge gap becomes even more pronounced given the advent of partial heart transplantation, a procedure designed to implant isolated human heart valves in young patients. This study aims to investigate the effects of IRI on aortic valvular endothelial cells (VECs), valvular interstitial cells (VICs), and whole leaflet cultures (no separation of VECs and VICs). We employed two conditions: hypoxic cold storage reperfusion (HCSR) and normothermia (NT). Key markers, secreted protein acidic and cysteine rich (SPARC) (osteonectin), and inducible nitric oxide synthase (iNOS2) were evaluated. In the isolated cells under HCSR, VICs manifested a significant 15-fold elevation in SPARC expression compared to NT (p = 0.0016). Conversely, whole leaflet cultures exhibited a 1-fold increment in SPARC expression in NT over HCSR (p = 0.0011). iNOS2 expression in VECs presented a marginal rise in HCSR, whereas, in whole leaflet settings, there was a 1-fold ascent in NT compared to HCSR (p = 0.0003). Minor escalations in the adhesion molecules intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), E-selection, and P-selection were detected in HCSR for whole leaflet cultures, albeit without statistical significance. Additionally, under HCSR, VICs released a markedly higher quantity of IL-6 and IL-8, with respective p-values of 0.0033 and <0.0001. Interestingly, the IL-6 levels in VECs remained consistent across both HCSR and NT conditions. These insights lay the groundwork for understanding graft IRI following partial heart transplantation and hint at the interdependent dynamic of VECs and VICs in valvular tissue.
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Affiliation(s)
- Jennie H. Kwon
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA; (J.H.K.); (M.A.)
- Department of Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Miriam Atteya
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA; (J.H.K.); (M.A.)
| | - Alekhya Mitta
- School of Medicine, University of South Carolina, Columbia, SC 29208, USA;
| | - Andrew D. Vogel
- Division of Research, Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA;
| | - Russell A. Norris
- Department of Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Taufiek Konrad Rajab
- Division of Pediatric Cardiovascular Surgery, Arkansas Children’s Hospital, Little Rock, AR 72202, USA
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17
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Asfari A, Doyle EA, Jay GD, Aristizabal N, Manchikalapati A, Rahman AKMF, Hock KM, Borasino S, Ambalavanan N, Schmidt TA, Rhodes LA. Plasma proteoglycan 4: a novel biomarker for acute lung injury after pediatric cardiac surgery. Transl Pediatr 2023; 12:1668-1675. [PMID: 37814710 PMCID: PMC10560364 DOI: 10.21037/tp-23-194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 10/11/2023] Open
Abstract
Background Identification of biological molecules related to post cardiopulmonary bypass (CPB) lung injury could help diagnose, predict and potentially impact patient's clinical course after cardiac surgery. Proteoglycan 4 (PRG4) initially identified as potential biomarker for patients with prolonged mechanical ventilation following CPB in a prior study. To further validate these findings, we sought to understand the association of lower plasma PRG4 with prolonged mechanical ventilation and worse lung compliance in a larger cohort of pediatric patients post CPB. Methods Retrospective chart review study. Pediatric Cardiac Intensive Care Unit, Tertiary Hospital. Infants <1 year old with tetralogy of Fallot, ventricular septal defect, or atrioventricular septal defect who underwent surgical repair 2012-2020 and had stored plasma samples in our biorepository were screened for inclusion. Patients with mechanical ventilation before surgery were excluded. Patients were divided into quartiles based on postoperative duration of mechanical ventilation (control <25th percentile, study >75th percentile). Preoperative and 48-hour postoperative samples for each cohort (20 patients each) were tested for PRG4 level using enzyme-linked immunosorbent assay (ELISA) technique. Results Study group had lower lung compliance, higher mean airway pressure and higher oxygen need postoperative when compared to control group. Plasma PRG4 levels before surgery and 48 hours postoperative were lower in study group compared to control group (P=0.0232 preoperative; P=0.0016 postoperative). Plasma PRG4 levels were compared preoperative to PRG4 levels postoperative in both group, there was no statistically significant difference (study group: P=0.0869; control group: P=0.6500). Conclusions Lower levels of plasma PRG4 is associated with longer duration of mechanical ventilation, worse ventilator compliance and higher oxygen requirement after cardiac surgery in our patient population. Further validation of this finding in a larger and more diverse patient population is necessary prior to its application at the bedside.
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Affiliation(s)
- Ahmed Asfari
- Section of Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erica A. Doyle
- Biomedical Engineering Department, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - Gregory D. Jay
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Natalia Aristizabal
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ananya Manchikalapati
- Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kristal M. Hock
- Section of Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Santiago Borasino
- Section of Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Namasivayam Ambalavanan
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tannin A. Schmidt
- Biomedical Engineering Department, School of Dental Medicine, UConn Health, Farmington, CT, USA
| | - Leslie A. Rhodes
- Section of Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Martin SM, Tucci M, Spinella PC, Ducruet T, Fergusson DA, Freed DH, Lacroix J, Poirier N, Sivarajan VB, Steiner ME, Willems A, Garcia Guerra G. Effect of red blood cell storage time in pediatric cardiac surgery patients: A subgroup analysis of a randomized controlled trial. JTCVS Open 2023; 15:454-467. [PMID: 37808065 PMCID: PMC10556812 DOI: 10.1016/j.xjon.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/19/2023] [Accepted: 04/11/2023] [Indexed: 10/10/2023]
Abstract
Objective This study aimed to determine whether or not transfusion of fresh red blood cells (RBCs) reduced the incidence of new or progressive multiple organ dysfunction syndrome compared with standard-issue RBCs in pediatric patients undergoing cardiac surgery. Methods Preplanned secondary analysis of the Age of Blood in Children in Pediatric Intensive Care Unit study, an international randomized controlled trial. This study included children enrolled in the Age of Blood in Children in Pediatric Intensive Care Unit trial and admitted to a pediatric intensive care unit after cardiac surgery with cardiopulmonary bypass. Patients were randomized to receive either fresh (stored ≤7 days) or standard-issue RBCs. The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured up to 28 days postrandomization or at pediatric intensive care unit discharge, or death. Results One hundred seventy-eight patients (median age, 0.6 years; interquartile range, 0.3-2.6 years) were included with 89 patients randomized to the fresh RBCs group (median length of storage, 5 days; interquartile range, 4-6 days) and 89 to the standard-issue RBCs group (median length of storage, 18 days; interquartile range, 13-22 days). There were no statistically significant differences in new or progressive multiple organ dysfunction syndrome between fresh (43 out of 89 [48.3%]) and standard-issue RBCs groups (38 out of 88 [43.2%]), with a relative risk of 1.12 (95% CI, 0.81 to 1.54; P = .49) and an unadjusted absolute risk difference of 5.1% (95% CI, -9.5% to 19.8%; P = .49). Conclusions In neonates and children undergoing cardiac surgery with cardiopulmonary bypass, the use of fresh RBCs did not reduce the incidence of new or progressive multiple organ dysfunction syndrome compared with the standard-issue RBCs. A larger trial is needed to confirm these results.
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Affiliation(s)
- Sophie M. Martin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Marisa Tucci
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Philip C. Spinella
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
| | - Thierry Ducruet
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Darren H. Freed
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Nancy Poirier
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Venkatesan B. Sivarajan
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Marie E. Steiner
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
| | - Ariane Willems
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
| | - Gonzalo Garcia Guerra
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - Age of Blood in Children in Pediatric Intensive Care Unit Trial Investigators
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Canadian Critical Care Trials Group
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Pediatric Acute Lung Injury and Sepsis Investigators Network
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the BloodNet Pediatric Critical Care Blood Research Network
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
| | - the Groupe Francophone de Réanimation et Urgences Pédiatriques∗
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Departments of Surgery and Critical Care Medicine, Pittsburgh University, Pittsburgh, Pa
- Unité de recherche clinique appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Cardiac Surgery, Sainte Justine and Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
- Pediatric Cardiac Intensive Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
- Divisions of Hematology/Oncology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, Minn
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Hospital, Leiden, The Netherlands
- Pediatric Intensive Care, Department of Pediatrics, Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada
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19
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Stevens H, Gallant J, Foster J, Horne D, Krmpotic K. Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. J Pediatr Intensive Care 2023; 12:167-172. [PMID: 37565014 PMCID: PMC10411109 DOI: 10.1055/s-0041-1730933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.
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Affiliation(s)
- Hannah Stevens
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Julien Gallant
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Jennifer Foster
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Pediatric Congenital Cardiac Surgery, IWK Health, Halifax, Canada
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Kristina Krmpotic
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
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20
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Norozi K, Subasri M, Diaz LA, Honjo O. Left atrial appendage aneurysm in pediatrics: Case study and literature review. Front Cardiovasc Med 2023; 10:1211619. [PMID: 37636313 PMCID: PMC10449248 DOI: 10.3389/fcvm.2023.1211619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.
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Affiliation(s)
- Kambiz Norozi
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
- Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany
| | - Mathushan Subasri
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Luis Altamirano Diaz
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
| | - Osami Honjo
- Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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21
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Gładki M, Bednarek PR, Owecki W. Case report: A unique quadruple coexisting anomaly-scimitar syndrome, atrial septal defect, vascular ring, and pulmonary sequestration. Front Pediatr 2023; 11:1214900. [PMID: 37534199 PMCID: PMC10392937 DOI: 10.3389/fped.2023.1214900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
The article describes a successful clinical outcome in the case of a 5-month old female with a diagnosis of incomplete vascular ring of aberrant right subclavian artery and ostium secundum atrial septal defect associated with partial anomalous pulmonary venous return of scimitar syndrome type, coexisting with right pulmonary sequestration. During hospitalization, surgical correction of the heart defect and resection of the lung sequestration were performed. To the best of our knowledge, described constellation of defects is a unique phenomenon, posing a challenge for complex treatment and disease management.
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Affiliation(s)
- Marcin Gładki
- Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł R. Bednarek
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Owecki
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
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22
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Narula J, Saxena R, Bindal S. Bombay blood group for pediatric cardiac surgery in the era of a pandemic: Newer challenges call for desperate measures! Ann Card Anaesth 2023; 26:343-345. [PMID: 37470538 PMCID: PMC10451144 DOI: 10.4103/aca.aca_154_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 07/21/2023] Open
Abstract
Bombay blood group is one of the rarest blood types with a prevalence of 1 per 10,000 population in India. Children and adults of this blood group can receive autologous blood or blood from an individual with a Bombay phenotype only. Children with grown-up uncorrected cyanotic heart disease are associated with a high risk of perioperative hemorrhagic diathesis and may require multiple blood transfusions. Arrangement of adequate Bombay blood group units for pediatric cardiac surgery is a unique challenge. The COVID-19 pandemic brought about additional difficulties in the procurement of blood components due to donor hostility. Despite the associated risks, pre-operative multi-session autologous blood harvest under monitored anesthesia care was planned in a 16-year-old child and four units of autologous blood were harvested and preserved for performing total correction surgery.
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Affiliation(s)
- Jitin Narula
- Department of Anesthesiology, Narayana Super Specialty Hospital, DLF Phase III, Sector 24, Gurugram, Haryana, India
| | - Rachit Saxena
- Department of Cardio Thoracic and Vascular Surgery, Narayana Super Specialty Hospital, DLF Phase III, Sector 24, Gurugram, Haryana, India
| | - Sonia Bindal
- Blood Bank Department, Narayana Super Specialty Hospital, DLF Phase III, Sector 24, Gurugram, Haryana, India
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23
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Ranucci M, Di Dedda U, Isgrò G, Giamberti A, Cotza M, Cornara N, Baryshnikova E. Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study. J Clin Med 2023; 12:3907. [PMID: 37373602 DOI: 10.3390/jcm12123907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP throughout the whole perioperative course in this patient population. This retrospective, non-inferiority, propensity-matched study investigates an FFP-free strategy compared to an FFP-based strategy. METHODS Among patients <10 kg with available viscoelastic measurements, 18 patients who received a total FFP-free strategy were compared to 27 patients (1:1.5 propensity matching) receiving an FFP-based strategy. The primary endpoint was chest drain blood loss in the first 24 postoperative hours. The level of non-inferiority was settled at a difference of 5 mL/kg. RESULTS The 24-h chest drain blood loss difference between groups was -7.7 mL (95% confidence interval -20.8 to 5.3) in favor of the FFP-based group, and the non-inferiority hypothesis was rejected. The main difference in coagulation profile was a lower level of fibrinogen concentration and FIBTEM maximum clot firmness in the FFP-free group immediately after protamine, at the admission in the ICU and for 48 postoperative hours. No differences in transfusion of red blood cells or platelet concentrate were observed; patients in the FFP-free group did not receive FFP but required a larger dose of fibrinogen concentrate and prothrombin complex concentrate. CONCLUSIONS An FFP-free strategy in infants < 10 kg operated with CPB is technically feasible but results in an early post-CPB coagulopathy that was not completely compensated with our bleeding management protocol.
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Affiliation(s)
- Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Umberto Di Dedda
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giuseppe Isgrò
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Alessandro Giamberti
- Department of Congenital Heart Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Mauro Cotza
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Noemi Cornara
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
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24
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Yamamoto T, Schindler E. Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery. Curr Opin Anaesthesiol 2023; 36:324-333. [PMID: 36924271 PMCID: PMC10155682 DOI: 10.1097/aco.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review article was to highlight the enhanced recovery protocols in pediatric cardiac surgery, including early extubation, rapid mobilization and recovery, reduction of opioid-related side effects, and length of pediatric ICU and hospital stay, resulting in decreased costs and perioperative morbidity, by introducing recent trends in perioperative anesthesia management combined with peripheral nerve blocks. RECENT FINDINGS Efficient postoperative pain relief is essential for realizing enhanced recovery strategies, especially in pediatric patients. It has been reported that approaches to perioperative pain management using additional peripheral nerve blocks ensure early extubation and a shorter duration of ICU and hospital stay. This article provides an overview of several feasible musculofascial plane blocks to achieve fast-track anesthesia management for pediatric cardiac surgery. SUMMARY Recent remarkable advances in combined ultrasound techniques have made it possible to perform various peripheral nerve blocks. The major strategy underlying fast-track anesthesia management is to achieve good analgesia while reducing perioperative opioid use. Furthermore, it is important to consider early extubation not only as a competition for time to extubation but also as the culmination of a qualitative improvement in the outcome of treatment for each patient.
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Affiliation(s)
- Tomohiro Yamamoto
- Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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25
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Skidmore S, Hill MA, Bishara K, Konsek H, Kwon JH, Brockbank KGM, Rajab TK. Morbidity and Mortality of Heterotopic Partial Heart Transplantation in Rodent Models. J Cardiovasc Dev Dis 2023; 10:234. [PMID: 37367399 PMCID: PMC10299259 DOI: 10.3390/jcdd10060234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Unrepairable congenital heart valve disease is an unsolved problem in pediatric cardiac surgery because there are no growing heart valve implants. Partial heart transplantation is a new type of transplant that aims to solve this problem. In order to study the unique transplant biology of partial heart transplantation, animal models are necessary. This study aimed to assess the morbidity and mortality of heterotopic partial heart transplantation in rodent models. This study assessed two models. The first model involved transplanting heart valves from donor animals into the abdominal aortic position in the recipient animals. The second model involved transplanting heart valve leaflets into the renal subcapsular position of the recipient animals. A total of 33 animals underwent heterotopic partial heart transplantation in the abdominal aortic position. The results of this model found a 60.61% (n = 20/33) intraoperative mortality rate and a 39.39% (n = 13/33) perioperative mortality rate. Intraoperative mortality was due to vascular complications from the procedure, and perioperative mortality was due to graft thrombosis. A total of 33 animals underwent heterotopic partial heart transplantation in the renal subcapsular position. The results of this model found a 3.03% (n = 1/33) intraoperative mortality rate, and the remaining 96.97% survived (n = 32/33). We conclude that the renal subcapsular model has a lower mortality rate and is technically more accessible than the abdominal aortic model. While the heterotopic transplantation of valves into the abdominal aortic position had significant morbidity and mortality in the rodent model, the renal subcapsular model provided evidence for successful heterotopic transplantation.
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Affiliation(s)
- Savannah Skidmore
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Morgan A. Hill
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Katherine Bishara
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Haley Konsek
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jennie H. Kwon
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kelvin G. M. Brockbank
- Tissue Testing Technologies LLC, North Charleston, SC 29425, USA
- Department of Bioengineering, Clemson University, Charleston, SC 29425, USA
| | - Taufiek Konrad Rajab
- Department of Pediatric Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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26
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Busack C, Rana MS, Deutsch N, Matisoff A. Reply. Paediatr Anaesth 2023. [PMID: 37052229 DOI: 10.1111/pan.14675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Christopher Busack
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Md Sohel Rana
- Joseph E. Robert, Jr., Center for Surgical Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Nina Deutsch
- Division of Cardiac Anesthesia, The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, District of Columbia, USA
| | - Andrew Matisoff
- Division of Cardiac Anesthesia, The George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, District of Columbia, USA
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27
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Bhende VV, Pathan SR, Sharma TS, Kumar A, Majmudar HP, Patel VA. Risk factors of sepsis and prevalence of multidrug-resistant organisms in pediatric cardiac surgery in tertiary care teaching rural hospital in India: A retrospective observational study. Health Sci Rep 2023; 6:e1191. [PMID: 37073300 PMCID: PMC10105830 DOI: 10.1002/hsr2.1191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
Background and aims Cardiac surgery and cardiopulmonary bypass result in an immunoparalyzed state in children making them susceptible to sepsis and other hospital-acquired infections. Therefore, identification of the risk factors of sepsis would lead to appropriate management. The current study seeks to evaluate the prevalence of sepsis and risk factors linked to sepsis in pediatric cardiac surgical patients and the subsequent prevalence of multidrug-resistant organisms. Methods A retrospective, single-center observational study was conducted including 100 pediatric patients admitted to the pediatric intensive care unit (ICU) after cardiac surgery between January 2017 and February 2018. All patient data were obtained from the medical record department of the hospital. Patient case report form comprised demography, surgery details, preoperative and postoperative hematological reports, and clinical details. After collecting the data, chi-square test and logistic regression analysis were used to determine the risk factors linked to sepsis. Results The prevalence of sepsis in our population was 27% and the mortality rate due to sepsis was 1%. The only statistically significant risk factor for sepsis we discovered in this analysis was prolonged ICU stay for more than 5 days. A total of eight patients had blood cultures positive for bacterial infection. The alarming finding was that all eight were infected with multidrug-resistant organisms, demanding the last line of antibacterials. Conclusion Our study indicates that special clinical care is required when ICU stay is prolonged to lower the risk of sepsis. These new and upcoming infections not only promote high mortality and morbidity rates but also contribute to increased cost of care due to the use of newer broad-spectrum antibiotics and longer hospital stay. The high prevalence of multidrug-resistant organisms is unacceptable in the current scenario and hospital infection and prevention control play a crucial role in minimizing such infections.
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Affiliation(s)
- Vishal V. Bhende
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Sohilkhan R. Pathan
- Clinical Research Co‐ordinator, Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Tanishq S. Sharma
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
- Department of Community MedicineSAL Institute of Medical SciencesAhmedabadGujaratIndia
| | - Amit Kumar
- Department of Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Hardil P. Majmudar
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Vishal A. Patel
- Clinical Research Co‐ordinator, Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
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28
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Sujana CS, Wadile S, Srinivas CS, Banpurkar AM, Murthy PR, Kulkarni S. Clinical profile and outcomes of multisystem inflammatory syndrome in children associated with COVID-19 virus after surgery for congenital heart defects. Ann Pediatr Cardiol 2023; 16:87-93. [PMID: 37767163 PMCID: PMC10522151 DOI: 10.4103/apc.apc_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/14/2022] [Accepted: 02/13/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction To study the clinical presentation, laboratory profile, echocardiographic details, management, and outcomes of children who were diagnosed to have multisystem inflammatory syndrome in children (MIS-C) in the immediate postoperative period after surgery for congenital heart defects (CHDs). Materials and Methods This is a prospective case-control study that included children diagnosed to have MIS-C in the postoperative period based on clinical signs, rise in inflammatory markers, and echocardiographic features of ventricular dysfunction or coronary involvement. Management included intravenous immunoglobulin (IVIG), steroids, and antiplatelet medications in addition to routine postoperative care. Out of the 461 children who underwent surgery for CHD between April 1st, 2021, and November 30th, 2021, 18 children were diagnosed with MIS-C. After the initial routine postoperative course, all 18 children had sudden worsening in clinical and laboratory parameters. Other causes such as bacterial infection were ruled out. All of these children had features of MIS-C with ventricular dilatation and dysfunction, coronary artery involvement, and reactive COVID-19 immunoglobulin G antibody. There was a significant improvement in coronary artery dimensions after IVIG administration (P = 0.001). The involvement of the left main coronary artery was associated with significantly increased length of intensive care unit (ICU) and hospital stay (P = 0.019). Mean ICU and hospital stay was prolonged in the MIS-C group. There were two deaths in this group due to severe left ventricular dysfunction. Conclusions During the pandemic, a proportion of patients undergoing elective cardiac surgery may develop unexpected worsening in clinical status due to MIS-C. A high index of suspicion and prompt treatment with IVIG and steroids may be helpful in improving outcomes.
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Affiliation(s)
- Chitturi Sai Sujana
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
| | - Santosh Wadile
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
| | - Chitturi Subrahmanya Srinivas
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
| | - Ashishkumar Moreshwar Banpurkar
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
| | - Prabhatha Rashmi Murthy
- Department of Pediatric Cardiac Surgery, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care and Training in Pediatric Cardiac Skills, Navi Mumbai, Maharashtra, India
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Narula J, Bansal P, Rajput N. Indispensable Role of Transesophageal Echocardiography in Double-Chamber Right Ventricle Repair Surgery. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00120-9. [PMID: 36990803 DOI: 10.1053/j.jvca.2023.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
Double-chamber right ventricle repair surgery requires the excision of anomalous obstructive muscular or fibromuscular bundles in the right ventricular outflow tract. Because of the close proximity of key structures in the right ventricular outflow tract, the surgery is extremely challenging and requires precise resection. Underresection of the muscle bands can lead to significant residual gradients in the postoperative period, whereas overenthusiastic resection can cause iatrogenic injury to surrounding structures. Various techniques like Hegar sizing by the surgeons, direct chamber pressure measurement, transesophageal echocardiography, and epicardial echocardiography can guide the surgeons about the adequacy of repair. Transesophageal echocardiography is crucial at each step, as it can precisely determine the exact site of obstruction in the preoperative period. Postoperatively, it helps determine the adequacy of surgical repair and identification of inadvertent iatrogenic complications.
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Affiliation(s)
- Jitin Narula
- Department of Anesthesia, Narayana Super Specialty Hospital, Gurugram, Haryana, India; Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences, Faridabad, Haryana, India.
| | - Piyush Bansal
- Department of Anesthesia, Narayana Super Specialty Hospital, Gurugram, Haryana, India
| | - Nitin Rajput
- Department of Cardio Thoracic and Vascular Surgery, Narayana Super Specialty Hospital, Gurugram, Haryana, India
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Ohliger S, Harb A, Al-Haddadin C, Bennett DP, Frazee T, Hoffmann C. Addition of Deep Parasternal Plane Block to Enhanced Recovery Protocol for Pediatric Cardiac Surgery. Local Reg Anesth 2023; 16:11-18. [PMID: 36814520 PMCID: PMC9940490 DOI: 10.2147/lra.s387631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose This study aims to evaluate if the addition of deep parasternal plane blocks to a pre-existing enhanced recovery pathway for pediatric cardiac surgery improves outcomes. Patients and Methods A retrospective review through an EMR query from June 2019 to June 2021 was performed for patients less than 18 years of age who underwent cardiac surgery via median sternotomy and were extubated immediately following surgery in a single academic tertiary care hospital. Patients receiving deep parasternal blocks as part of an enhanced recovery protocol were compared to similar patients from the year prior to block implementation. Results The primary outcome was intraoperative and postoperative opioid consumption. Secondary outcomes were pain scores, intensive care unit (ICU) length of stay and time to first oral intake. There was a statistically significant reduction in intraoperative opioid administration and pain scores in the first 24 hours post-operatively. There was also a statistically significant reduction in ICU length of stay. There was no statistically significant difference in post-operative opioid consumption and time to first oral intake. Conclusion Bilateral deep parasternal blocks may reduce opioid consumption, provide effective postoperative pain control, and result in decreased length of intensive care unit stay across both simple and complex pediatric cardiac procedures when added to a pre-existing enhanced recovery protocol.
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Affiliation(s)
- Shelley Ohliger
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA,Correspondence: Shelley Ohliger, Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA, Tel +1 216 844 7340, Fax +1 216 844 3780, Email
| | - Alain Harb
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA
| | - Caroline Al-Haddadin
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA
| | - David P Bennett
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA
| | - Tiffany Frazee
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA
| | - Cassandra Hoffmann
- Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USA
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Cındık N, Gökdemir M, Çelik M, Günaydın AÇ. Risk factors for and incidence of hospital-acquired infections after cardiac surgery in children with congenital heart disease: a single center experience. Turk J Pediatr 2023; 65:769-777. [PMID: 37853968 DOI: 10.24953/turkjped.2022.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD). METHODS Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development. RESULTS The patients` median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p < 0.05). In logistic regression analysis, surgical weight < 5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p < 0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD. CONCLUSIONS In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.
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Affiliation(s)
- Nimet Cındık
- Department of Pediatric Cardiology, Konya Practice and Research Center, Başkent University, Konya
| | - Mahmut Gökdemir
- Department of Pediatric Cardiology, Konya Practice and Research Center, Başkent University, Konya
| | - Mehmet Çelik
- Department of Cardiovascular Surgery, Konya Practice and Research Center, Başkent University, Konya, Türkiye
| | - Asım Çağrı Günaydın
- Department of Cardiovascular Surgery, Konya Practice and Research Center, Başkent University, Konya, Türkiye
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Abstract
INTRODUCTION Modified ultrafiltration (MUF) is employed at the termination of cardiopulmonary bypass (CPB) in pediatric and neonatal patients undergoing congenital heart surgery to reduce the accumulation of total body water thus increasing the concentration of red blood cells and the other formed elements in the circulation. Modified ultrafiltration has been reported to remove circulating pro-inflammatory mediators that result in systemic inflammatory response syndrome (SIRS) postoperatively. METHODS Four hundred patients undergoing cardiac surgery requiring cardiopulmonary bypass and weighing less than or equal to 12 kg were retrospectively evaluated for the effectiveness of MUF. After the termination of CPB, blood was withdrawn through the aortic cannula and passed through a hemoconcentrator attached to the blood cardioplegia set and returned to the patient through the venous cannula. The entire CPB circuit volume in addition to the patient's circulating blood volume were concentrated until the hematocrit value displayed on the CDI cuvette within the MUF circuit reached 45% or there was no more volume to safely remove. At the same time a full unit of FFP can be infused as water is being removed, thus maintaining euvolemia. RESULTS MUF was performed in all 400 patients with no MUF-related complications. Following the conclusion of MUF, anecdotal observations included improved surgical hemostasis, improved hemodynamic parameters, decreased transfusion requirements, and decreased ventilator times. CONCLUSIONS Complete MUF enables the clinician to safely raise the post-CPB hematocrit to at least 40% while potentially removing mediators that could result in SIRS. In addition a full unit of FFP can be administered while maintaining euvolemia.
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Affiliation(s)
- David A Palanzo
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Robert K Wise
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Karl R Woitas
- Perfusion Department, Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Pediatric Cardiovascular Research Center, Departments of Pediatrics, Surgery and Biomedical Engineering, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Joseph B Clark
- Pediatric Cardiac Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Pediatric Cardiac Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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Burzyńska J, Jaworski R, Maruszewski B, Kansy A, Dzierżanowska-Fangrat K. Perioperative Antibiotic Prophylaxis in Pediatric Cardiac Surgery-Simple Is Better. Antibiotics (Basel) 2022; 12. [PMID: 36671267 DOI: 10.3390/antibiotics12010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Pediatric cardiac surgery requires perioperative antibiotic prophylaxis (PAP) to reduce the risk of surgical site infections. However, the complexity of these procedures and the metabolic immaturity of children impede the establishment of PAP regimens that are both efficacious and in line with antimicrobial stewardship (AMS). In this study, we compared two PAP regimens: cefazolin with gentamicin (in a retrospective group) and cefazolin only (prospectively) in children undergoing elective cardiac surgery. In the prospective group, additional elements of AMS were introduced, i.e., restricted access to cefazolin and more diligent use of empirical antibiotics proceeded by consultation with an AMS team. The rate of surgical site infections (SSI), the scope of PAP deviations, and the postoperative use of antibiotics other than PAP within 30 days after surgery were analyzed. There were no significant differences in the rate of SSIs between the groups (3.9% vs. 1.2% in the prospective and retrospective groups, respectively (p = 0.35)). However, in the prospective group, the PAP violation was significantly reduced compared with the retrospective group (full compliance with the PAP regimen was 45.5% vs. 4.8%, p < 0.001, respectively). In addition, a reduction of postoperative antibiotic use was observed in the prospective group (0.991 vs. 1.932 defined daily doses, respectively).
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Zeng X, Shi S, Sun Y, Feng Y, Tan L, Lin R, Li J, Duan H, Shu Q, Li H. A time-aware attention model for prediction of acute kidney injury after pediatric cardiac surgery. J Am Med Inform Assoc 2022; 30:94-102. [PMID: 36287639 PMCID: PMC9748588 DOI: 10.1093/jamia/ocac202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/16/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery, and the early detection of AKI may allow for timely preventive or therapeutic measures. However, current AKI prediction researches pay less attention to time information among time-series clinical data and model building strategies that meet complex clinical application scenario. This study aims to develop and validate a model for predicting postoperative AKI that operates sequentially over individual time-series clinical data. MATERIALS AND METHODS A retrospective cohort of 3386 pediatric patients extracted from PIC database was used for training, calibrating, and testing purposes. A time-aware deep learning model was developed and evaluated from 3 clinical perspectives that use different data collection windows and prediction windows to answer different AKI prediction questions encountered in clinical practice. We compared our model with existing state-of-the-art models from 3 clinical perspectives using the area under the receiver operating characteristic curve (ROC AUC) and the area under the precision-recall curve (PR AUC). RESULTS Our proposed model significantly outperformed the existing state-of-the-art models with an improved average performance for any AKI prediction from the 3 evaluation perspectives. This model predicted 91% of all AKI episodes using data collected at 24 h after surgery, resulting in a ROC AUC of 0.908 and a PR AUC of 0.898. On average, our model predicted 83% of all AKI episodes that occurred within the different time windows in the 3 evaluation perspectives. The calibration performance of the proposed model was substantially higher than the existing state-of-the-art models. CONCLUSIONS This study showed that a deep learning model can accurately predict postoperative AKI using perioperative time-series data. It has the potential to be integrated into real-time clinical decision support systems to support postoperative care planning.
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Affiliation(s)
- 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
| | - Shanshan Shi
- CICU, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuhan Sun
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, 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
| | - Linhua Tan
- CICU, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ru Lin
- CICU, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- 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
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- Cardiac Surgery, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Haomin Li
- Clinical Data Center, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Magunia H, Nester J, Sandoval Boburg R, Schlensak C, Rosenberger P, Hofbeck M, Keller M, Neunhoeffer F. Abdominal and Peripheral Tissue Oxygen Supply during Selective Lower Body Perfusion for the Surgical Repair of Congenital Heart Disease: A Pilot Study. J Cardiovasc Dev Dis 2022; 9:jcdd9120436. [PMID: 36547433 PMCID: PMC9782002 DOI: 10.3390/jcdd9120436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Lower body perfusion (LBP) may be a strategy for maintaining organ perfusion during congenital heart disease surgery. It is hypothesized that renal and lower limb oxygen supply during LBP is superior to off-pump surgery and comparable to that of a standard cardiopulmonary bypass (CPB). Methods: in this prospective single-center study, patients aged <1 year were recruited if they were scheduled for a correction of aortic arch anomalies using antegrade cerebral perfusion and LBP (group 1), a repair of coarctation during aortic cross-clamping (group 2), or surgery under whole-body CPB (group 3). Renal (prefix “r”) and peripheral (prefix “p”) oxygen saturation (SO2), hemoglobin amount (Hb), blood velocity (Velo), and blood flow (Flow) were measured noninvasively. Results: A total of 23 patients were included (group 1, n = 9; group 2, n = 5; group 3, n = 9). Compared to the baseline values, rSO2 and pSO2 decreased significantly in group 2 compared to groups 1 and 3. Conversely, rHB significantly increased in group 2 compared to groups 1 and 3, reflecting abdominal venous stasis. Compared to group 3, group 1 showed a significantly lower pFlow during CPB; however, rFlow, pFlow, and pVelo did not differ. Conclusion: according to these observations, LBP results in an improved renal oxygen supply compared to off-pump surgery and may prove to be a promising alternative to conventional CPB.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Jana Nester
- Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Rodrigo Sandoval Boburg
- Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Christian Schlensak
- Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 1, 72076 Tuebingen, Germany
| | - Marius Keller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-(0)7071-2986564; Fax: +49-(0)7071-295533
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 1, 72076 Tuebingen, Germany
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Scharoun J, Rong LQ. The evolving role of dexmedetomidine in pediatric cardiac surgery: Beyond anxiolysis. J Card Surg 2022; 37:4243-4245. [PMID: 35748296 PMCID: PMC9789201 DOI: 10.1111/jocs.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Jacques Scharoun
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Lisa Q. Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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Elhaddad AM, Youssef MF, Ebad AA, Abdelsalam MS, Kamel MM. Effect of Ventilation Strategy During Cardiopulmonary Bypass on Arterial Oxygenation and Postoperative Pulmonary Complications After Pediatric Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2022; 36:4357-4363. [PMID: 36184472 DOI: 10.1053/j.jvca.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the effects of 3 ventilation strategies during cardiopulmonary bypass (CPB) on arterial oxygenation and postoperative pulmonary complications (PPCs). DESIGN A prospective, randomized, controlled study. SETTING A single-center tertiary teaching hospital. PARTICIPANTS One hundred twenty pediatric patients undergoing elective repair of congenital acyanotic heart diseases with CPB. INTERVENTIONS Patients were assigned randomly into 3 groups according to ventilation strategy during CPB as follows: (1) no mechanical ventilation (NOV), (2) continuous positive airway pressure (CPAP) of 5 cmH2O, (3) low tidal volume (LTV), pressure controlled ventilation (PCV), respiratory rate (RR) 20-to-30/min, and peak inspiratory pressure adjusted to keep tidal volume (Vt) 2 mL/kg. MEASUREMENTS AND MAIN RESULTS The PaO2/fraction of inspired oxygen (FIO2) ratio and PaO2 were higher in the 5 minutes postbypass period in the LTV group but were nonsignificant. The PaO2/FIO2 ratio and PaO2 were significant after chest closure and 1 hour after arrival to the intensive care unit with a higher PaO2/FIO2 ratio and PaO2 in the LTV group. Regarding the oxygenation index, the LTV group was superior to the NOV group at the 3 time points, with lower values in the LTV group. There were no significant differences in the predictive indices among the 3 groups, including the extubation time, and postoperative intensive care unit stays days. The incidence of PPCs did not significantly differ among the 3 groups. CONCLUSIONS Maintaining ventilation during CPB was associated with better oxygenation and did not reduce the incidence of PPCs in pediatric patients undergoing cardiac surgery.
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Affiliation(s)
- Ahmed Mohamed Elhaddad
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt.
| | - Mohamed Farouk Youssef
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt
| | - Abdelhay Abdelgayed Ebad
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt
| | - Mohamed Sabry Abdelsalam
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt
| | - Mohamed Maher Kamel
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children's Hospital, via Al Kasr Al Aini, Old Cairo, Cairo Governorate, Egypt
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Sethi Y, Patel N, Kaka N, Desai A, Kaiwan O, Sheth M, Sharma R, Huang H, Chopra H, Khandaker MU, Lashin MMA, Hamd ZY, Emran TB. Artificial Intelligence in Pediatric Cardiology: A Scoping Review. J Clin Med 2022; 11:jcm11237072. [PMID: 36498651 PMCID: PMC9738645 DOI: 10.3390/jcm11237072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
The evolution of AI and data science has aided in mechanizing several aspects of medical care requiring critical thinking: diagnosis, risk stratification, and management, thus mitigating the burden of physicians and reducing the likelihood of human error. AI modalities have expanded feet to the specialty of pediatric cardiology as well. We conducted a scoping review searching the Scopus, Embase, and PubMed databases covering the recent literature between 2002-2022. We found that the use of neural networks and machine learning has significantly improved the diagnostic value of cardiac magnetic resonance imaging, echocardiograms, computer tomography scans, and electrocardiographs, thus augmenting the clinicians' diagnostic accuracy of pediatric heart diseases. The use of AI-based prediction algorithms in pediatric cardiac surgeries improves postoperative outcomes and prognosis to a great extent. Risk stratification and the prediction of treatment outcomes are feasible using the key clinical findings of each CHD with appropriate computational algorithms. Notably, AI can revolutionize prenatal prediction as well as the diagnosis of CHD using the EMR (electronic medical records) data on maternal risk factors. The use of AI in the diagnostics, risk stratification, and management of CHD in the near future is a promising possibility with current advancements in machine learning and neural networks. However, the challenges posed by the dearth of appropriate algorithms and their nascent nature, limited physician training, fear of over-mechanization, and apprehension of missing the 'human touch' limit the acceptability. Still, AI proposes to aid the clinician tomorrow with precision cardiology, paving a way for extremely efficient human-error-free health care.
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Affiliation(s)
- Yashendra Sethi
- PearResearch, Dehradun 248001, India
- Department of Medicine, Government Doon Medical College, Dehradun 248001, India
| | - Neil Patel
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Nirja Kaka
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Ami Desai
- Department of Medicine, SMIMER Medical College, Surat 395010, India
| | - Oroshay Kaiwan
- PearResearch, Dehradun 248001, India
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
- Correspondence: (O.K.); (Z.Y.H.); (T.B.E.)
| | - Mili Sheth
- Department of Medicine, GMERS Gandhinagar, Gandhinagar 382012, India
| | - Rupal Sharma
- Department of Medicine, Government Medical College, Nagpur 440003, India
| | - Helen Huang
- Faculty of Medicine and Health Science, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Mayeen Uddin Khandaker
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Bandar Sunway 47500, Malaysia
| | - Maha M. A. Lashin
- Department of Biomedical Engineering, College of Engineering, Princess Nourah bint Abdulrahman University, P.O. 84428, Riyadh 11671, Saudi Arabia
| | - Zuhal Y. Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. 84428, Riyadh 11671, Saudi Arabia
- Correspondence: (O.K.); (Z.Y.H.); (T.B.E.)
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
- Correspondence: (O.K.); (Z.Y.H.); (T.B.E.)
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Palamattam DJ, Sreedhar R, Gadhinglajkar SV, Dash PK, Sukesan S. Bedside Chest Ultrasound in Postoperative Pediatric Cardiac Surgery Patients: Comparison With Bedside Chest Radiography. J Cardiothorac Vasc Anesth 2022; 36:4039-4044. [PMID: 35953404 DOI: 10.1053/j.jvca.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting. DESIGN A prospective observational study. SETTING At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center. PARTICIPANTS One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases. INTERVENTIONS After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1. MEASUREMENTS AND MAIN RESULTS The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k = 0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k = 0.787) between CUS and CXR regarding the necessity for interventions. CONCLUSIONS The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.
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Affiliation(s)
- Don J Palamattam
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rupa Sreedhar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
| | - Shrinivas V Gadhinglajkar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Prasanta K Dash
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Einhorn LM, Andrew BY, Nelsen DA, Ames WA. Analgesic Effects of a Novel Combination of Regional Anesthesia After Pediatric Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2022; 36:4054-4061. [PMID: 35995635 PMCID: PMC10497036 DOI: 10.1053/j.jvca.2022.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether the use of regional anesthesia in children undergoing congenital heart surgery was associated with differences in outcomes when compared to surgeon-delivered local anesthetic wound infiltration. DESIGN A retrospective cohort study. SETTING At a single pediatric tertiary care center. PARTICIPANTS Pediatric patients who underwent primary repair of septal defects between January 1, 2018, and March 31, 2022. INTERVENTIONS The patients were grouped by whether they received surgeon-delivered local anesthetic wound infiltration or bilateral pectointercostal fascial blocks (PIFBs) and a unilateral rectus sheath block (RSB) on the side ipsilateral to the chest tube. MEASUREMENTS AND MAIN RESULTS Using overlap propensity score-weighted models, the authors examined postoperative opioid requirements (morphine milliequivalents per kilogram), pain scores, length of stay, and time under general anesthesia (GA). Eighty-nine patients were eligible for inclusion and underwent analysis. In the first 12 hours postoperatively, the block group used fewer morphine equivalents per kilogram versus the infiltration group, 0.27 ± 0.2 v 0.64 ± 0.42, with a weighted estimated decrease of 0.39 morphine equivalents per kilogram (95% CI -0.52 to -0.25; p < 0.001), and had lower pain scores, 3.2 v 1.6, with a weighted estimated decrease of 1.7 (95% CI -2.3 to -1.1; p < 0.001). The length of stay and time under GA also were shorter in the block group with weighted estimated decreases of 22 hours (95% CI -33 to -11; p = 0.001) and 18 minutes (95% CI -34 to -2; p = 0.03), respectively. CONCLUSIONS Bilateral PIFBs and a unilateral RSB on the side ipsilateral to the chest tube is a novel analgesic technique for sternotomy in pediatric patients. In this retrospective study, these interventions were associated with decreases in postoperative opioid use, pain scores, and hospital length of stay without prolonging time under GA.
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Affiliation(s)
- Lisa M Einhorn
- Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Benjamin Y Andrew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Derek A Nelsen
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Warwick A Ames
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Lindhardt RB, Kronborg JR, Wanscher M, Andersen LW, Gjedsted J, Ravn HB. Evaluation of Thromboelastography 6s prognostication of fibrinogen supplementation in pediatric cardiac surgery. Acta Anaesthesiol Scand 2022; 66:1166-1173. [PMID: 36054262 PMCID: PMC9826011 DOI: 10.1111/aas.14144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Implementation of point-of-care tests is recommended to provide tailored substitution during cardiac surgery. The measurement and substitution of fibrinogen have gained particular interest since it is the first coagulation factor to become depleted during cardiac surgery. However, the prognostic ability of thromboelastography (TEG) 6s has not been evaluated in pediatric patients. The aim of the present study was to describe patient characteristics of infants receiving fibrinogen substitution during cardiac surgery and evaluate the prognostic ability of TEG6s after weaning off cardiopulmonary bypass (CPB). METHODS Infants undergoing congenital cardiac surgery with CPB were retrospectively included (n = 279) between January 2017 to July 2019. Patient and perioperative data were collected on the day of surgery until 6:00 AM the next morning. Hemostatic capacity was assessed with TEG6s. The efficacy of TEG-functional fibrinogen-maximal amplitude (TEG-FF-MA) measurements for the prediction of intraoperative bleeding, and thereby cryoprecipitate need, was evaluated by a sensitivity and specificity analysis. RESULTS Among 174 children with TEG-FF-MA data, 147 (84%) received cryoprecipitate intraoperatively. Cryoprecipitate administration was associated with younger age 66 (10-132) versus 98 (45-204) days (p = .044), higher RACHS-1 classification, and intraoperative bleeding 21 (11-47) versus 5 (3-13) ml/kg (p < .001, mean difference 29 ml/kg [CI: 8-50]). Median TEG-FF-MA values were lower in transfused children 7.6 (5.3-11.0) versus 10.5 (7.3-13.4) mm (p = .004, mean difference - 2.4 mm [CI: -4.1 to - 0.73]). The volume of cryoprecipitate was associated with bypass time, TEG-FF-MA values, and in particular intraoperative bleeding volumes. A TEG-FF-MA threshold of 10.0 mm, resulted in sensitivity: 74%, specificity: 56%, positive predictive value: 80%, and a negative predictive value of 47% for the prediction of intraoperative bleeding (>10 ml/kg) and consequently a need of cryoprecipitate transfusion. CONCLUSION Fibrinogen substitution in infants was associated with younger age and higher RACHS-1 category. The prognostic value of TEG6s was evaluated, and cryoprecipitate transfusion was related to TEG-FF-MA values, but also CPB-time, surgical complexity, and in particular excessive intraoperative bleeding. A clear-cut threshold for TEG-FF-MA is difficult to establish in infants undertaken congenital heart surgery.
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Affiliation(s)
- Rasmus Bo Lindhardt
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jonas Rønne Kronborg
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Lars Willy Andersen
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jakob Gjedsted
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark,Institute of Clinical Medicine, Health FacultyUniversity of CopenhagenCopenhagenDenmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark,Institute of Clinical Medicine, Health FacultyUniversity of CopenhagenCopenhagenDenmark,Institute of Clinical MedicineUniversity of Southern DenmarkOdenseDenmark,Department of Anesthesiology and Intensive CareOdense University HospitalOdenseDenmark
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Kaushik J, Vijayakumar R, Soundaravalli B, Shoba M, Jenit O, Anisha S. One-year experience after adoption of an on-table extubation protocol following pediatric cardiac surgery. Ann Card Anaesth 2022; 25:422-428. [PMID: 36254905 PMCID: PMC9732950 DOI: 10.4103/aca.aca_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To report our initial experience with on-table extubation following cardiac surgery for congenital heart disease, assessing its efficacy and safety, and the potential for fast-tracking these patients through the intensive care unit (ICU). METHODS We decided to implement a multidisciplinary protocol aiming toward on-table extubation following congenital cardiac surgery at our hospital. Between December 2018 and January 2020, 376 patients underwent congenital cardiac surgery. The management strategy involved choosing the patients preoperatively, a specific anesthetic technique, application of a standard extubation protocol, multidisciplinary team approach, and perioperative echocardiogram for assessment of surgical repair. Relevant data were collected and analyzed. RESULTS Out of the 376 patients who underwent congenital cardiac surgery during the study period, 44 patients were extubated on-table. Although a majority of these patients belonged to Risk Adjustment for Congenital Heart Surgery-1 score (RACHS-1) 1 and 2 categories, 18% of the patients who were extubated on-table were of RACHS-3 category. This included a wide spectrum of anatomical substrates such as endocardial cushion defects, pulmonary venous anomalies, single ventricle physiology, valvular defects, and others such as cor triatriatum and sinus of Valsalva aneurysm. There was no in-hospital mortality related to on-table extubation. Only one patient was reintubated following on-table extubation resulting in a reintubation rate of 2.27% among those patients extubated on-table. The patients extubated on-table had a shorter ICU stay (25.89 ± 7.20 h) compared with those patients who underwent delayed extubation (59.30 ± 6.80 h). The duration of the hospital stay was also significantly reduced in these patients (91.09 ± 20.40 h) leading to an earlier discharge compared with those patients who underwent delayed extubation (134.40 ± 16.20 h). CONCLUSION On-table extubation is an attractive alternative in limited-resource environments to enhance recovery in patients following congenital cardiac malformations. Owing to the lack of significant comorbidities such as Chronic Obstructive Pulmonary Disease (COPD) in this patient population, corrective surgery for cardiac malformation usually optimizes the cardiorespiratory status. This results in more chances of successful extubation immediately following surgery. However, this requires proper perioperative planning, a careful discussion about the choice of patients, adoption of an extubation protocol, and most importantly, a multidisciplinary team approach. It is associated with low morbidity and mortality, with reduced length of stay in the ICU and hospital. This preliminary study demonstrated that on-table extubation is feasible following congenital cardiac surgery at our center and greatly reduces the intensive care requirements. This article focuses mainly on the decision-making process which determines the ideal candidates for on-table extubation and the anesthetic protocol implemented in a low-resource environment to enable the same.
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Affiliation(s)
- Jothinath Kaushik
- Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Raju Vijayakumar
- Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | | | - Menon Shoba
- Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Osborn Jenit
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shajan Anisha
- Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
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Alotaibi RK, Saleem AS, Alsharef FF, Alnemer ZA, Saber YM, Abdelmohsen GA, Bahaidarah SA. Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery: A single-center experience. Saudi Med J 2022; 43:1111-1119. [PMID: 36261205 PMCID: PMC9994501 DOI: 10.15537/smj.2022.43.10.20220275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate the incidence of arrhythmia in the early postoperative period and to identify its risk factors among pediatric patients following cardiac surgery at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between 2015-2020. METHODS Out of 1242 patients, a total of 821 aged <18 years who underwent cardiac surgery were included in this retrospective cohort carried out in June 2021 at KAUH, Jeddah, Saudi Arabia. Information retrieved from the hospital medical records had patients' demographics, types of arrhythmias, hemodynamic stability, electrolyte disturbances, cardiopulmonary bypass (CPB), and aortic cross-clamp (AXC) durations. Univariate and multivariate logistic regression analyses were used to evaluate the possible risk factors associated with postoperative arrhythmia. RESULTS Of the 821 patients, 140 (17.1%) developed arrhythmia postoperatively. The most common arrhythmias were junctional ectopic tachycardia (JET, 51.4%), atrioventricular block (27.1%), and supraventricular tachycardia (10%). The majority of cases occurred on the first day postoperatively (79.3%). Patients with postoperative arrhythmias had a more prolonged CPB (p=0.0001) and AXC (p=0.005) time, electrolytes disturbances (p=0.021), and hemodynamic instability (p=0.0001) than other patients. CONCLUSION Postoperative arrhythmia, especially JET, is common after pediatric cardiac surgery. Prolonged cardiopulmonary bypass, prolonged aortic cross-clamping, electrolytes disturbances, and hemodynamic instability are possible risk factors for postoperative cardiac arrhythmias.
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Affiliation(s)
- Rahaf K. Alotaibi
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Abdulmuti S. Saleem
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Fai F. Alsharef
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Zainab A. Alnemer
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Yazan M. Saber
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Gaser A. Abdelmohsen
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
| | - Saud A. Bahaidarah
- From the Faculty of Medicine (Alotaibi, Saleem, Alsharef, Alnemer, Saber), King Abdulaziz University; from the Division of Paediatric Cardiology (Abdelmohsen, Bahaidarah), Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, and from the Division of Paediatric Cardiology (Abdelmohsen), Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Eygpt.
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Sun Y, Yao Y. Vasoactive-inotropic score/inotropic score and short-term outcomes in pediatrics undergoing cardiac surgery: A retrospective analysis from single center. J Card Surg 2022; 37:3654-3661. [PMID: 36069143 DOI: 10.1111/jocs.16914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY This study aimed to investigate the association between vasoactive-inotropic score/inotropic score (VIS/IS) and short-term outcomes in pediatric patients after cardiac surgery at a tertiary care center in an unselected pediatric population in China. METHODS This study carried out retrospective observation of 401 patients between April and June 2021 at a tertiary care center. VIS and IS were assessed intraoperatively (VIS-op, IS-op) and 2 h (VIS2h, IS2h), 24 h (VIS24h, IS24h), and 48 h (VIS48h, IS48h) postoperatively. The primary outcome was prolonged mechanical ventilation (PMV). Secondary outcomes included poor prognosis and length of stay in the pediatric intensive care unit and hospital. RESULTS Mean age of the included pediatric patients was 26.5 months. Pediatric cardiac procedures were performed within an average operation duration of 167.6 ± 70.8 min. Overall, the PMV group (n = 93) experienced significantly longer ACC duration, cardiopulmonary bypass duration, operation duration, and a higher prevalence of fluid accumulation overload than the non-PMV group (n = 93). Multivariate logistic regression analysis revealed that longer operation duration (odds ratio [OR]: 1.015; 95% confidence interval [95% CI]: 1.003, 1.026; p = .012) and higher VIS48h (OR: 1.188; 95% CI: 1.077, 1.311; p = .001) were strongest predictors for PMV. VIS48h had better discrimination power for PMV than other time intervals, and the area under the curve was 0.780 (95% CI, 0.721, 0.839; p = .000). CONCLUSIONS VIS48h independently predicted short-term outcomes after cardiac surgery in an unselected pediatric population in China and showed better prediction accuracy and discrimination capability than other time intervals.
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Affiliation(s)
- Yanting Sun
- Department of Anesthesiology, Baoji High-Tech Hospital, Baoji, Shaanxi, China.,Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuntai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Gopalakrishnan RM, Nair AR, Sudhakar A, Jayant A, Balachandran R, Neema PK, Kumar RK. Culture-negative sepsis after pediatric cardiac surgery: Incidence and outcomes. Ann Pediatr Cardiol 2022; 15:442-446. [PMID: 37152519 PMCID: PMC10158468 DOI: 10.4103/apc.apc_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 03/02/2023] Open
Abstract
Background Significant proportion of congenital heart surgery (CHS) children exhibit sepsis, but have negative blood culture and defined "culture negative sepsis (CNS)." Aims and Objectives Retrospective analysis of CNS patients undergoing CHS. Material and Methods 437 consecutive CHS children grouped as controls (antibiotic prophylaxis), CNS, and culture positive sepsis (CPS). Results Incidences of CNS and CPS were 16% and 7%. Median mechanical ventilation (MV) in hours among CPS, CNS, and control was 116 (45-271), 63 (23-112), and 18 (6-28) (P < 0.001), respectively. Multivariable linear regression identified CPS (median ratio: 3.1 [2.3-4.1], P < 0.001), CNS (median ratio: 5.6 [3.7-8.4], P < 0.001), and weight (kg) (median ratio: 0.98 [0.96-0.99], P = 0.009) as associations of MV. Intensive care unit (ICU) stay (hours) was 192 (120-288) in CNS, 288 (156-444) in CPS, and 72 (48-120) in controls (P < 0.0001). Multivariable linear regression showed CNS (median ratio: 2.4 [2.0-2.9], P< 0.001) CPS (median ratio: 3.3 [2.5-4.4], P < 0.001), and weight (median ratio: 0.98 [0.97-0.99], P ≤ 0.001) prolonging ICU stay. Mortality was 10.7%, 2.9% and 1.2% in CPS, CNS, and control (P = 0.03). Multivariable regression identified CPS an independent predictor of mortality with odds ratio 8.6 (1.7-44.9; P = 0.010). 11.26% patients in CNS and 79.3% in CPS received antibiotics for more than 10 days. Conclusion Incidence of CNS was 16%; duration of MV and ICU stay and mortality was significantly less in CNS than CPS patients.
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Affiliation(s)
- Rajesh M. Gopalakrishnan
- Division of Pediatric Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Arjun Ramachandran Nair
- Division of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Abish Sudhakar
- Division of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Aveek Jayant
- Department of Anesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatanam, Andhra Pradesh, India
| | - Rakhi Balachandran
- Division of Pediatric Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Praveen Kumar Neema
- Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Raman Krishna Kumar
- Division of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Scott JP, Tanem JM, Tomita-Mitchell A, Hoffman GM, Niebler RA, Liang HL, Simpson PM, Stamm KD, North PE, Mitchell ME. Elevated nuclear and mitochondrial cell-free deoxyribonucleic acid measurements are associated with death after infant cardiac surgery. J Thorac Cardiovasc Surg 2022; 164:367-375. [PMID: 35144816 DOI: 10.1016/j.jtcvs.2021.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Mortality rates following pediatric cardiac surgery with cardiopulmonary bypass have declined over decades, but have plateaued in recent years. This is in part attributable to persistent issues with postoperative global inflammation and myocardial dysfunction, commonly manifested by systemic inflammatory response syndrome and low cardiac output syndrome, respectively. Quantified cell-free DNA (cfDNA), of nuclear or mitochondrial origin, has emerged as a biomarker for both inflammation and myocardial injury. Recent data suggest that nuclear cfDNA (ncfDNA) may quantify inflammation, whereas mitochondrial cfDNA (mcfDNA) may correlate with the degree of myocardial injury. We hypothesize that threshold levels of ncfDNA and mcfDNA can be established that are sensitive and specific for postoperative mortality mediated through independent pathways, and that association will be enhanced with combined analysis. METHODS Prospective observational study of infants younger than age 1 year undergoing planned surgery with cardiopulmonary bypass. The study received institutional review board approval. Samples were drawn before skin incision, immediately after completion of cardiopulmonary bypass, and subsequently at predetermined intervals postoperatively. Association of early postoperative ncfDNA and mcfDNA levels with mortality were assessed by logistic regression with cut-points chosen by receiving operating characteristic curve exploration. RESULTS Data were available in 59 patients. Median age and weight were 122 days (interquartile range, 63-154 days) and 4.9 kg (interquartile range, 3.9-6.2 kg). Median STAT category was 3 (interquartile range, 1-4). The primary outcome of death was met in 3 out of 59 (5%). Combined analysis of ncfDNA and mcfDNA levels at 12 hours after the initiation of cardiopulmonary bypass with death at a threshold of 50 ng/mL ncfDNA and 17 copies/μL mcfDNA yielded 100% sensitivity and negative predictive value. The specificity (91%) and positive predictive value (38%) increased through combined analysis compared with univariate analysis. Combined analysis exhibited high specificity (93%) and negative predictive value (78%) for prolonged (>30 postoperative days) hospitalization. CONCLUSIONS Combined analysis of early postoperative ncfDNA and mcfDNA can stratify risk of mortality and prolonged hospitalization following infant cardiac surgery. Evaluation of both ncfDNA and mcfDNA to identify states of generalized inflammation and myocardial injury may allow for targeted interventions and improved outcomes.
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Affiliation(s)
- John P Scott
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis.
| | - Justinn M Tanem
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Aoy Tomita-Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - George M Hoffman
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Robert A Niebler
- Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Huan Ling Liang
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Pippa M Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Karl D Stamm
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Paula E North
- Division of Pediatric Pathology, Department of Pathology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
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Jaworski R, Kansy A, Friedman-Gruszczynska J, Bieganowska K, Mirkowicz-Malek M. Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair. Medicina (Kaunas) 2022; 58:687. [PMID: 35630104 DOI: 10.3390/medicina58050687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Over the years, surgical repair of total anomalous pulmonary venous connection (TAPVC) outcomes have improved, however, morbidity and mortality still remain significant. This study aims to assess the early and long-term outcomes of surgical treatment of TAPVC children, operated on between 2006 and 2016, in one pediatric center in Poland. Materials and Methods: Diagnostics, surgical treatment, and follow-up data from 83 patients were collected. In addition, survival and risk factor analyses, control echocardiographic, and electrocardiographic examinations were performed. Results: In the analyzed group (n = 83), there were seven hospital deaths (within 30 days after the operation) (8.4%) and nine late deaths (10.8%). The mean follow-up time was 5.5 years, and, for patients who survived, it was 7.1 years. The mean survival time in patients with completed follow-up (n = 70) was 10.3 years; the overall five-year survival rate was 78.4%. Independent mortality risk factors were type I TAPVC, single ventricle physiology, time from admission to operation, intensive care unit stay, postoperative hospital stay, and temporary kidney insufficiency requiring dialysis. Conclusions: The presence of single ventricle physiology and the supracardiac subtype of TAPVC might be negative prognostic factors, while normal heart physiology presents with good post-repair results. This study indicates that cardiac arrhythmias may occur. Morbidity and mortality, related to surgical TAPVC correction, still remain significant.
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Wang G, Gao Y, Zhou G, Feng Z. Pectoralis major muscle turnover flap reconstruction for treatment of deep sternal wound infection in infants and children. J Card Surg 2022; 37:2309-2314. [PMID: 35506747 DOI: 10.1111/jocs.16567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study is to assess the therapeutic effect and applicability of pectoralis major muscle turnover flap (PMMTF) reconstruction for treatment of deep sternal wound infection (DSWI) after cardiac surgery in infants and children. METHODS From March 2013 to October 2021, 23 patients with DSWI after cardiac surgery underwent PMMTF reconstruction. The data and outcomes of the patients were retrospectively analyzed. RESULTS Twenty patients were treated with unilateral PMMTF reconstruction, and three patients were treated by bilateral PMMTF. All of the sternal wounds healed successfully. All patients survived and were discharged without evidence of infection. In a follow-up period, ranging from 15 to 83 months (mean 32.6 months), all patients demonstrated normal development with no limitations to limb movements. There were no signs of chronic sternal infection in all of them. CONCLUSION PMMTF reconstruction is a simple, feasible, and effective treatment of DSWI after cardiac surgery in infants and children, with minimal developmental problems.
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Affiliation(s)
- Gang Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Yongshun Gao
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Gengxu Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Zhichun Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Pediatrics, The Seventh Medical Center of the PLA General Hospital, Beijing, China
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49
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Pollak U, Abarbanel I, Salem Y, Serraf AE, Mishaly D. Dominant Ventricular Morphology and Early Postoperative Course After the Fontan Procedure. World J Pediatr Congenit Heart Surg 2022; 13:346-352. [PMID: 35446208 PMCID: PMC9024023 DOI: 10.1177/21501351221081246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Single ventricle heart disease comprises a wide variety of critical heart defects that lead to the provision of systemic cardiac output by one dominant ventricle. It requires staged surgical palliation that culminates in Fontan circulation. Dominant ventricular morphology in single ventricle patients reportedly has an impact on postoperative morbidity and mortality with varying results. The objectives of this study were to examine the association between ventricular morphology and the early postoperative course after the Fontan procedure. Methods A retrospective cohort study in a tertiary referral pediatric medical center that included 98 consecutive patients who underwent Fontan procedure between October 2009 and May 2016. Postoperative outcomes were compared between patients with left ventricular morphology and those with right ventricular morphology (crude effect and regression analysis). Results Patients with right ventricular morphology had longer postoperative hospitalizations compared to patients with left ventricular morphology (26.5 days vs 18.2 days, respectively, P = .028), higher postoperative maximal vasoactive-inotropic scores (25.6 vs 12.4, P = .02), higher serum lactate levels (7.7 mmol/L vs 6.4 mmol/L, P = .03), higher proportions of ventilation throughout 24 h or more (16 patients [38%] vs 8 patients [14%], P = .009), higher proportions of ventricular dysfunction (12 patients [29%] vs 5 patients [9%], P = .0001), and lower blood oxygen saturation levels at discharge (87% vs 92%, P = .03). Conclusions The Fontan procedure in patients with right ventricular morphology is associated with longer postoperative hospitalization and worse early postoperative characteristics (ventricular dysfunction and atrioventricular valve regurgitation) as well as higher rates of early, transient signs of sub-optimal postoperative hemodynamics compared to those with left ventricular morphology.
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Affiliation(s)
- Uri Pollak
- Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Jerusalem, Israel.,Pediatric Cardiology, Hadassah University Medical Center, Jerusalem, Israel.,Pediatric Extracorporeal Support Program, Hadassah University Medical Center, Jerusalem, Israel.,58884The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Inbar Abarbanel
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Yishay Salem
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric Cardiology, Edmond J. Safra International Congenital Heart Center, 146925The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Alain E Serraf
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, 26744The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - David Mishaly
- The Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.,Pediatric and Congenital Cardiac Surgery, Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, 26744The Chaim Sheba Medical Center, Tel Hashomer, Israel
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50
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Cantinotti M, Marchese P, Scalese M, Franchi E, Assanta N, Koestenberger M, Pizzuto A, Pak V, Santoro G, Jani V, Kutty S, Giordano R. Atrial Function Impairments after Pediatric Cardiac Surgery Evaluated by STE Analysis. J Clin Med 2022; 11. [PMID: 35566624 DOI: 10.3390/jcm11092497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Applications of atrial speckle tracking echocardiography (STE) strain (ε) analysis in pediatric cardiac surgery have been limited. This study aims to evaluate the feasibility of atrial STE ε analysis and the progression of atrial ε values as a function of post-operative time in children after pediatric cardiac surgery. Methods: 131 children (mean 1.69 ± 2.98; range 0.01−15.16 years) undergoing cardiac surgery were prospectively enrolled. Echocardiographic examinations were performed pre-operatively and at 3 different post-operative intervals: Time 1 (24−36 h), Time 2 (3−5 days), Time 3 (>5 days, before discharging). The right and left atrium longitudinal systolic contractile (Ct), Conduit (Cd), and Reservoir (R) ε were evaluated with a novel atrial specific software with both P- and R-Gating methods. One hundred and thirty-one age-matched normal subjects (mean 1.7 ± 3.2 years) were included as controls. Results: In all, 309 examinations were performed over the post-operative times. For each post-operative interval, all STE atrial ε parameters assessed were significantly lower compared to controls (all p < 0.0001). The lowest atrial ε values were found at Time 1, with only partial recovery thereafter (p from 0.02 to 0.04). All atrial ε values at discharge were decreased compared to the controls (all p < 0.0001). Significant correlations of the atrial ε values with cardio-pulmonary-bypass time, left and right ventricular ε values (p < 0.05), and ejection fraction (p < 0.05) were demonstrated. Conclusions: Atrial ε is highly reduced after surgery with only partial post-operative recovery in the near term. Our study additionally demonstrates that post-surgical atrial and ventricular ε responses correlated with each other.
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