Oncotic pressure and paediatric cardiopulmonary bypass: establishing baseline data for complex congenital cardiac surgery and its relation to risk stratification.

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 378-382 ◽  
Author(s):  
Richard Crook ◽  
Richard Issitt
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Risk Stratification ◽  
Negative Correlation ◽  
Risk Adjustment ◽  
Congenital Heart ◽  
Significant Negative Correlation ◽  
Baseline Data ◽  
Albumin Concentration ◽  
Paediatric Patients

Objectives: Colloid osmotic pressure (COP) is a major determinant of fluid shift in paediatric patients undergoing corrective surgery for congenital heart disease (CHD) using cardiopulmonary bypass (CPB). However, very few baseline data are available for those patients requiring surgery within the first few weeks and months of life. Our aim was to determine if our CHD population exhibited COP similar to that of other extremely ill subsets of patients and, if so, whether this related to risk stratification model scores. Methods: Thirty consecutive patients under 10 kg underwent cardiac surgery with CPB. Data were collected on COP, albumin concentration, prime composition, post-operative length of ventilation and intensive care unit (ICU) stay as well as risk stratification utilising Risk Adjustment for Congenital Heart Surgery (RACHS-1) and Partial Risk Adjustment in Surgery (PRAiS) scoring systems. Results: The patients had a mean pre-bypass COP of 13.9±2.5 mmHg. A significant negative correlation was observed between pre-operative baseline COP and length of ventilation (r=0.7; p<0.001) and a significant negative correlation between PRAiS (r=0.64; p<0.001) and RACHS-1 (r=0.5; p=0.004) scores and baseline COP was seen. Conclusions: Neonatal and paediatric patients requiring surgical correction of complex congenital cardiac malformations exhibit extremely low baseline COP, comparable to other sick neonatal populations, and are lower than those previously reported. Baseline COP correlates significantly with predicted survival rates and time spent on a ventilator.

Thrombin generation in paediatric patients with congenital heart disease

2008 ◽  
Vol 28 (S 01) ◽  
pp. S61-S66 ◽  
Author(s):  
G. Cvirn ◽  
A. Rosenkranz ◽  
B. Leschnik ◽  
W. Raith ◽  
W. Muntean ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Negative Correlation ◽  
Congenital Heart ◽  
Thrombin Generation ◽  
Significant Negative Correlation ◽  
Peak Height ◽  
Global Test ◽  
Paediatric Patients ◽  
Age Range

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.

Optimizing response of the neonate and infant to cardiopulmonary bypass

2005 ◽  
Vol 15 (S1) ◽  
pp. 142-148 ◽  
Author(s):  
Ross M. Ungerleider
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Normal Anatomy ◽  
Complete Repair ◽  
Innovative Techniques

The evolution of cardiac surgery has led to increasing emphasis on complete repair of congenital heart defects early in life, nowadays increasingly performed in neonates or small infants. Good results have been achieved because of innovative techniques permitting reconstruction of normal anatomy, and restoration of normal physiology, before either the heart or the patient undergo deleterious adaptation to the congenitally abnormal physiology. Despite the ability surgically to correct complex defects in such small patients, limitations in outcome are sometimes encountered related to the systems necessary for repair. In particular, exposure to cardiopulmonary bypass may present the greatest challenge for these tiny patients.

scholarly journals The diagnostic value of combined indexes in Acute Renal injury after Cardiopulmonary Bypass Surgery in infants with Congenital Heart Disease

2020 ◽  
Author(s):  
Haifei Yu ◽  
Xinrui Wang ◽  
Qiang Chen ◽  
Liangpu Xu ◽  
Hua Cao
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Hepatic Function ◽  
Blood Oxygen ◽  
Acute Renal Injury ◽  
Blood Oxygen Saturation

Abstract Objective: To investigate the incidence and risk factors of acute renal injury (AKI) after cardiopulmonary bypass (CPB) cardiac surgery in infants with congenital heart disease(CHD). Methods: Single-center data from a total of 613 infants with congenital heart disease who underwent cardiothoracic surgery in Fujian Union Hospital.The included patients were divided into two groups according to the occurrence of AKI: AKI group (n = 68) and non-AKI group (n = 92). We obtained clinical data from the electronic hospitalization information system and the laboratory database. All infants were tested for serum creatinine at least twice within 12 hours of admission and after operation. We determined AKI events according to creatinine criteria for improving global prognosis of renal diseases.The general and clinical data of the infants were collected, and the related risk factors were explored by univariate analysis and Logistic regression analysis. Results: 160 patients had congruent lab and echocardiogram data foranalysis. Most of patients are male (56.26%). Original congenital cardiac malformation is similar with our study, the most common is left-to-right shunt CHD(58%), followed by right-to-left shunt CHD(18.75%). All patients showed differences in liver function, renal function, cardiac function and inflammatory indexes within 12 hours of admission and after operation(p<0.05). The AKI group and non-AKI group showed Significant statistical difference in arein age, serum myocardial enzyme , hepatic function, ejection fraction , hemoglobin , platelet count were significantly different meaning (p<0.05). Regression analyses showed that blood oxygen saturation (95%CI 1.003-2.999), CREA(95%CI 1.070-1.253), UREA(95%CI 1.180-3.325), CRP(95%CI 1.006-1.058), BNP(95%CI 0.999-1.000) at 12 hours postoperatively, and in admission to PCT (95%CI 0.461-0.936), Neu(95%CI 0.909-0.995), ALP(95%CI 1.070-1.253) , nadir intraoperative renal regional tissue oximetry to be independent predictors of postoperative kidney damage as measured by blood oxygen saturation, hepatic function, kidney function, cardiac function , Serum myocardial enzyme , inflammatory factor s and blood Routine . Conclusions: Choosing the best age for infants's cardiac surgery, actively preventing preoperative complica- tions, postoperative pneumonia, heart failure and hypoxia play an important role in preventing AKI.

A retrospective study of perioperative clinical seizures and epilepsy in children after operation for CHD

2021 ◽  
pp. 1-7
Author(s):  
Takeshi Ikegawa ◽  
Shin Ono ◽  
Kouji Yamamoto ◽  
Mikihiro Shimizu ◽  
Sadamitsu Yanagi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
White Matter ◽  
Risk Adjustment ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
White Matter Integrity ◽  
Partial Regression Coefficient ◽  
Clinical Seizure

Abstract This study investigated the incidence and risk factors of perioperative clinical seizure and epilepsy in children after operation for CHD. We included 777 consecutive children who underwent operation from January 2013 to December 2016 at Kanagawa Children’s Medical Center, Kanagawa, Japan. Perinatal, perioperative, and follow-up medical data were collected. Elastic net regression and mediation analysis were performed to investigate risk factors of perioperative clinical seizure and epilepsy. Anatomic CHD classification was performed based on the preoperative echocardiograms; cardiac surgery was evaluated using Risk Adjustment in Congenital Heart Surgery 1. Twenty-three (3.0%) and 15 (1.9%) patients experienced perioperative clinical seizure and epilepsy, respectively. Partial regression coefficient with epilepsy as the objective variable for anatomical CHD classification, Risk Adjustment in Congenital Heart Surgery 1, and the number of surgeries was 0.367, 0.014, and 0.142, respectively. The proportion of indirect effects on epilepsy via perioperative clinical seizure was 22.0, 21.0, and 33.0%, respectively. The 15 patients with epilepsy included eight cases with cerebral infarction, two cases with cerebral haemorrhage, and three cases with hypoxic-ischaemic encephalopathy; white matter integrity was not found. Anatomical complexity of CHD, high-risk cardiac surgery, and multiple cardiac surgeries were identified as potential risk factors for developing epilepsy, with a low rate of indirect involvement via perioperative clinical seizure and a high rate of direct involvement independently of perioperative clinical seizure. Unlike white matter integrity, stroke and hypoxic-ischaemic encephalopathy were identified as potential factors for developing epilepsy.

Stratification of complexity: The Risk Adjustment for Congenital Heart Surgery-1 Method and The Aristotle Complexity Score – past, present, and future

2008 ◽  
Vol 18 (S2) ◽  
pp. 163-168 ◽  
Author(s):  
Marshall Lewis Jacobs ◽  
Jeffrey Phillip Jacobs ◽  
Kathy J. Jenkins ◽  
Kimberlee Gauvreau ◽  
David R. Clarke ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Of Care ◽  
Risk Adjustment ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Case Mix ◽  
Objective Data ◽  
Complexity Score

AbstractMeaningful evaluation of quality of care must account for variations in the population of patients receiving treatment, or “case-mix”. In adult cardiac surgery, empirical clinical data, initially from tens of thousands, and more recently hundreds of thousands of operations, have been used to develop risk-models, to increase the accuracy with which the outcome of a given procedure on a given patient can be predicted, and to compare outcomes on non-identical patient groups between centres, surgeons and eras.In the adult cardiac database of The Society of Thoracic Surgeons, algorithms for risk-adjustment are based on over 1.5 million patients undergoing isolated coronary artery bypass grafting and over 100,000 patients undergoing isolated replacement of the aortic valve or mitral valve. In the pediatric and congenital cardiac database of The Society of Thoracic Surgeons, 61,014 operations are spread out over greater than 100 types of primary procedures. The problem of evaluating quality of care in the management of pediatric patients with cardiac diseases is very different, and in some ways a great deal more challenging, because of the smaller number of patients and the higher number of types of operations.In the field of pediatric cardiac surgery, the importance of the quantitation of the complexity of operations centers on the fact that outcomes analysis using raw measurements of mortality, without adjustment for complexity, is inadequate. Case-mix can vary greatly from program to program. Without stratification of complexity, the analysis of outcomes for congenital cardiac surgery will be flawed. Two major multi-institutional efforts have attempted to measure the complexity of pediatric cardiac operations: the Risk Adjustment in Congenital Heart Surgery-1 method and the Aristotle Complexity Score. Both systems were derived in large part from subjective probability, or expert opinion. Both systems are currently in wide use throughout the world and have been shown to correlate reasonably well with outcome.Efforts are underway to develop the next generation of these systems. The next generation will be based more on objective data, but will continue to utilize subjective probability where objective data is lacking. A goal, going forward, is to re-evaluate and further refine these tools so that, they can be, to a greater extent, derived from empirical data. During this process, ideally, the mortality elements of both the Aristotle Complexity Score and the Risk Adjustment in Congenital Heart Surgery-1 methodology will eventually unify and become one and the same. This review article examines these two systems of stratification of complexity and reviews the rationale for the development of each system, the current use of each system, the plans for future enhancement of each system, and the potential for unification of these two tools.

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