An Elevated Low Cardiac Output Syndrome Score Is Associated With Morbidity in Infants After Congenital Heart Surgery*

Abstract Background: Milrinone is a phosphodiesterase type 3 inhibitor that results in a positive inotropic effect in the heart through an increase in cyclic adenosine monophosphate. The purpose of this study was to evaluate circulating cyclic adenosine monophosphate and milrinone concentrations in milrinone treated paediatric patients undergoing congenital heart surgery. Methods: Single-centre prospective observational pilot study from January 2015 to December 2017 including children aged birth to 18 years. Milrinone and circulating cyclic adenosine monophosphate concentrations were measured at four time points through the first post-operative day and compared between patients with and without low cardiac output syndrome, defined using clinical and laboratory criteria. Results: Fifty patients were included. Nine (18%) developed low cardiac output syndrome. For all patients, 22% had single ventricle heart disease. The density and distribution of cyclic adenosine monophosphate concentrations varied between those with and without low cardiac output syndrome but were not significantly different. Milrinone concentrations increased in all patients. Paired t-tests demonstrated an increase in circulating cyclic adenosine monophosphate concentrations during the post-operative period among patients without low cardiac output syndrome. Conclusions: In this prospective observational study, circulating cyclic adenosine monophosphate concentrations increased in those without low cardiac output syndrome during the first 24 post-operative hours and milrinone concentrations increased in all patients. Further study of the utility of cyclic adenosine monophosphate concentrations in milrinone treated patients is necessary.

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Managing low cardiac output syndrome after congenital heart surgery

Critical Care Medicine ◽

10.1097/00003246-200110001-00004 ◽

2001 ◽

Vol 29 (Supplement) ◽

pp. S220-S230 ◽

Cited By ~ 87

Author(s):

David L. Wessel

Keyword(s):

Cardiac Output ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Novel approach for Recanalization and Limb Saving Following Acute Thrombosis of Upper Limb Arteries in Two Neonates After Congenital Heart Surgery

Klinische Pädiatrie ◽

10.1055/a-1258-4349 ◽

2020 ◽

Author(s):

Jameel Al- Ata ◽

Gaser Abdelmohsen ◽

Saud Bahaidarah ◽

Naif Alkhushi ◽

Zaher Zaher

Keyword(s):

Congenital Heart Disease ◽

Cardiac Output ◽

Congenital Heart ◽

Heart Surgery ◽

Heart Diseases ◽

Congenital Heart Surgery ◽

Low Cardiac Output ◽

Vascular Thrombosis ◽

Acute Thrombosis ◽

Novel Approach

IntroductionNeonates with congenital heart disease are at a high risk of vascular thrombosis. Thrombosis may occur due to vascular injury, increased blood viscosity secondary to polycythemia associated with congenital cyanotic heart diseases, or stasis of blood flow associated with low cardiac output (Schmidt B & Andrew M., Pediatrics 1995; 96: 939–943. Veldman A et al.,Vasc Health Risk Manag 2008; 4: 1337–1348).

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The implications of Milrinone Lactate in the Postoperative Clinical Management of Surgical Interventions for Congenital Heart Malformations in Children

Revista de Chimie ◽

10.37358/rc.17.11.5949 ◽

2017 ◽

Vol 68 (11) ◽

pp. 2658-2661

Author(s):

Mariana Anisoara (Ciorba) Puiac ◽

Horatiu Suciu ◽

Marius Ilie Ciorba ◽

Mihaela Maria Opris ◽

Hussam Al Hussein ◽

...

Keyword(s):

Cardiac Output ◽

Congenital Heart ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Hemodynamic Parameters ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Congenital Heart Malformations ◽

Heart Malformations

The purpose of the study was to prove to efficacy of Milrinone in the management of open heart surgery in children with congenital heart malformations, the link between Milrinone efficacy and the prevention of low cardiac output syndrome and Milrinone side effects. We conducted a retrospective study on a group of 24 patients, admitted to the Tg Mures Emergency Institute for Cardiovascular Diseases and Transplant, between August 2016 and February 2017. Milrinone was administered to children that underwent open heart surgery for different congenital heart malformations, using doses between 0.25 and 0.75 mcg per kg bodyweight, in continuous intravenous drip, before de-clamping of the Aorta, the procedures being conducted in extracorporeal circulation. We recorded demographic data, biological parameters of renal function, myocardial function and hemodynamic parameters, before and after surgery. The administration of Milrinone determined a reduction of incidence of low cardiac output syndrome, registering only 4 deaths, the survival rate being 83.33%, 13 cases presenting complications. Postoperatively we registered a significant improvement of the mean heart rate. Milrinone proved efficient in the re-establishment of hemodynamic parameters in patients with this type of clinical manifestations. Using Milrinone in children that undergo open heart surgery determines a decrease in incidence of low cardiac output syndrome, its� presence in the pharma market being necessary.

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Pre-operative neutrophil–lymphocyte ratio predicts low cardiac output in children after cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951120000487 ◽

2020 ◽

Vol 30 (4) ◽

pp. 521-525 ◽

Cited By ~ 2

Author(s):

Ilias Iliopoulos ◽

Matthew N. Alder ◽

David S. Cooper ◽

Enrique G. Villarreal ◽

Rohit Loomba ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Clinical Outcomes ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Low Cardiac Output ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Cell Counts

AbstractNeutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.

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