O-21 Alveolar recruitment strategy and PEEP improves right ventricular outflow impedance in paediatric patients undergoing cardiac surgery for congenital heart disease

SummaryThrombin generation was studied in paediatric patients with congenital heart disease (CHD) undergoing cardiac surgery using the calibrated automated thrombography (CAT) in terms of the lag time until the onset of thrombin formation, time to thrombin peak maximum (TTP), endogenous thrombin potential (ETP), and thrombin peak height. The suitability to determine the coagulation status of these patients was investigated. Patients, material, methods: CAT data of 40 patients with CHD (age range from newborn to 18 years) were compared to data using standard coagulation parameters such as prothrombin (FII), antithrombin (AT), tissue factor pathway inhibitor (TFPI), prothrombin fragment 1.2 (F 1.2), thrombin-antithrombin (TAT), activated partial thromboplastin time (aPTT), and prothrombin time (PT). Results: A significant positive correlation was seen between ETP and FII (p < 0.01; r = 0.369), as well as between peak height and F II (p < 0.01; r = 0.483). A significant negative correlation was seen between ETP and TFPI values (p < 0.05; r = –0.225) while no significant correlation was seen between peak height and TFPI. A significant negative correlation was seen between F 1.2 generation and ETP (p < 0.05; r = –0.254) and between F 1.2 generation and peak height (p < 0.05; r = –0.236). No correlation was seen between AT and ETP or peak. Conclusions: CAT is a good global test reflecting procoagulatory and inhibitory factors of the haemostatic system in paediatric patients with CHD.

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Quality of life and specific problems after cardiac surgery in adolescents and adults with congenital heart disease

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816790 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

FF Immer ◽

S Althaus ◽

PA Berdat ◽

JP Pfammatter ◽

H Saner ◽

...

Keyword(s):

Quality Of Life ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Adolescents And Adults

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Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

BMC Surgery ◽

10.1186/s12893-020-01009-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaoqiang Yin ◽

Mei Xin ◽

Sheng Ding ◽

Feng Gao ◽

Fan Wu ◽

...

Keyword(s):

Mechanical Ventilation ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Congenital Heart ◽

Prolonged Mechanical Ventilation ◽

Pulmonary Arterial ◽

Mechanical Ventilation Time

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

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Is alternative cardiac surgery an option in adults with congenital heart disease referred for thoracic organ transplantation?†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezs240 ◽

2012 ◽

Vol 43 (2) ◽

pp. 344-351 ◽

Cited By ~ 20

Author(s):

Andrew Robert Harper ◽

David Steven Crossland ◽

Gianluigi Perri ◽

John Jude O'Sullivan ◽

Milind Pralhad Chaudhari ◽

...

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Organ Transplantation ◽

Congenital Heart ◽

Thoracic Organ

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Down syndrome and congenital heart disease: perioperative planning and management

Journal of Congenital Cardiology ◽

10.1186/s40949-021-00061-3 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Dennis R. Delany ◽

Stephanie S. Gaydos ◽

Deborah A. Romeo ◽

Heather T. Henderson ◽

Kristi L. Fogg ◽

...

Keyword(s):

Congenital Heart Disease ◽

Down Syndrome ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Single Ventricle ◽

Heart Defects ◽

Careful Consideration ◽

Children With Down Syndrome ◽

Perioperative Planning

AbstractApproximately 50% of newborns with Down syndrome have congenital heart disease. Non-cardiac comorbidities may also be present. Many of the principles and strategies of perioperative evaluation and management for patients with congenital heart disease apply to those with Down syndrome. Nevertheless, careful planning for cardiac surgery is required, evaluating for both cardiac and noncardiac disease, with careful consideration of the risk for pulmonary hypertension. In this manuscript, for children with Down syndrome and hemodynamically significant congenital heart disease, we will summarize the epidemiology of heart defects that warrant intervention. We will review perioperative planning for this unique population, including anesthetic considerations, common postoperative issues, nutritional strategies, and discharge planning. Special considerations for single ventricle palliation and heart transplantation evaluation will also be discussed. Overall, the risk of mortality with cardiac surgery in pediatric patients with Down syndrome is no more than the general population, except for those with functional single ventricle heart defects. Underlying comorbidities may contribute to postoperative complications and increased length of stay. A strong understanding of cardiac and non-cardiac considerations in children with Down syndrome will help clinicians optimize perioperative care and long-term outcomes.

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