Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery

2018 ◽  
Vol 9 (6) ◽  
pp. 651-658 ◽  
Author(s):  
John S. Kim ◽  
Jon Kaufman ◽  
Sonali S. Patel ◽  
Marilyn Manco-Johnson ◽  
Jorge Di Paola ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Patient Characteristics ◽  
Platelet Inhibition ◽  
Inhibitory Effect ◽  
Congenital Heart Surgery ◽  
Data Set ◽  
Congenital Cardiac Surgery ◽  
Normal Platelet ◽  
Pediatric Analgesia

Background: Ketorolac is used for pediatric analgesia after surgery despite its known platelet inhibition via the arachidonic acid (AA) pathway. The degree of platelet inhibitory effect after cardiac surgery is not well characterized. Thromboelastography with platelet mapping (TEG-PM) is emerging as a frequently used test to evaluate platelet inhibition via the AA pathway. Methods: Post hoc analysis of a data set collected in a prospective observational cohort study evaluating platelet inhibition in children after congenital heart surgery with cardiopulmonary bypass (CPB). Categorization into two groups: (1) received ketorolac and (2) did not receive ketorolac for analgesia after surgery. The TEG-PM was evaluated at two time points (prior to surgery and 12-48 hours after CPB). Results: Fifty-three children were studied; mean age was 6.6 (range: 0.07-16.7) years and 45% (n = 24) were female. Participants were distributed into two groups by ketorolac use, 41 within the ketorolac group and 12 in the no ketorolac group. All 41 participants who received ketorolac had platelet inhibition and 11 (91.7%) of 12 participants who did not receive ketorolac had normal platelet function after surgery ( P < .0001). There was no difference in patient characteristics or clinical data between the two groups. Conclusions: Ketorolac use in a cohort of children after congenital cardiac surgery was associated with platelet inhibition via the AA pathway when evaluated by TEG-PM.

Analysis of regional congenital cardiac surgical outcomes in Florida using The Society of Thoracic Surgeons Congenital Heart Surgery Database

2009 ◽  
Vol 19 (4) ◽  
pp. 360-369 ◽  
Author(s):  
Jeffrey P. Jacobs ◽  
James A. Quintessenza ◽  
Redmond P. Burke ◽  
Mark S. Bleiweis ◽  
Barry J. Byrne ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Regional Analysis ◽  
The United States ◽  
Congenital Heart Surgery ◽  
Medical Services ◽  
Congenital Cardiac Surgery ◽  
Children's Medical Services

AbstractBackgroundFlorida is the fourth largest state in the United States of America. In 2004, 218,045 live babies were born in Florida, accounting for approximately 1744 new cases of congenital heart disease. We review the initial experience of The Society of Thoracic Surgeons Congenital Heart Surgery Database with a regional outcomes report, namely the Society of Thoracic Surgeons Florida Regional Report.MethodsEight centres in Florida provide services for congenital cardiac surgery. The Children’s Medical Services of Florida provide a framework for quality improvement collaboration between centres. All congenital cardiac surgical centres in Florida have voluntarily agreed to submit data to the Society of Thoracic Surgeons Database. The Society of Thoracic Surgeons and Duke Clinical Research Institute prepared a Florida Regional Report to allow detailed regional analysis of outcomes for congenital cardiac surgery.ResultsThe report of 2007 from the Society of Thoracic Surgeons Congenital Heart Surgery Database includes details of 61,014 operations performed during the 4 year data harvest window, which extended from 2003 through 2006. Of these operations, 6,385 (10.5%) were performed in Florida. Discharge mortality in the data from Florida overall, and from each Florida site, with 95% confidence intervals, is not different from cumulative data from the entire Society of Thoracic Surgeons Database, both for all patients and for patients stratified by complexity.ConclusionsA regional consortium of congenital heart surgery centres in Florida under the framework of the Children’s Medical Services has allowed for inter-institutional collaboration with the goal of quality improvement. This experience demonstrates, first, that the database maintained by the Society of Thoracic Surgeons can provide the framework for regional analysis of outcomes, and second, that voluntary regional collaborative efforts permit the pooling of data for such analysis.

A National Survey: Current Clinical Practice in Pediatric Anesthesia for Congenital Heart Surgery

2020 ◽  
Vol 11 (3) ◽  
pp. 257-264
Author(s):  
Torsten Baehner ◽  
Nicholas Kiefer ◽  
Shahab Ghamari ◽  
Ingo Graeff ◽  
Christopher Huett ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Anesthetic Management ◽  
Pediatric Anesthesia ◽  
Congenital Heart Surgery ◽  
Online Questionnaire ◽  
Volatile Agent ◽  
Congenital Cardiac Surgery ◽  
First Choice

Background: Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany. Methods: All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice. Results: Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers. Conclusion: This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.

scholarly journals Verification of data in congenital cardiac surgery

2008 ◽  
Vol 18 (S2) ◽  
pp. 177-187 ◽  
Author(s):  
David R. Clarke ◽  
Linda S. Breen ◽  
Marshall L. Jacobs ◽  
Rodney C.G. Franklin ◽  
Zdzislaw Tobota ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
United Kingdom ◽  
Thoracic Surgery ◽  
European Association ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Congenital Cardiac Surgery ◽  
The United Kingdom

AbstractAccurate, complete data is now the expectation of patients, families, payers, government, and even media. It has become an obligation of those practising congenital cardiac surgery. Appropriately, major professional organizations worldwide are assuming responsibility for the data quality in their respective registry databases.The purpose of this article is to review the current strategies used for verification of the data in the congenital databases of The Society of Thoracic Surgeons, The European Association for Cardio-Thoracic Surgery, and The United Kingdom Central Cardiac Audit Database. Because the results of the initial efforts to verify data in the congenital databases of the United Kingdom and Europe have been previously published, this article provides a more detailed look at the current efforts in North America, which prior to this article have not been published. The discussion and presentation of the strategy for the verification of data in the congenital heart surgery database of The Society of Thoracic Surgeons is then followed by a review of the strategies utilized in the United Kingdom and Europe. The ultimate goal of sharing the information in this article is to provide information to the participants in the databases that track the outcomes of patients with congenitally malformed hearts. This information should help to improve the quality of the data in all of our databases, and therefore increase the utility of these databases to function as a tool to optimise the management strategies provided to our patients.The need for accurate, complete and high quality Congenital Heart Surgery outcome data has never been more pressing. The public interest in medical outcomes is at an all time high and “pay for performance” is looming on the horizon. Information found in administrative databases is not risk or complexity adjusted, notoriously inaccurate, and far too imprecise to evaluate performance adequately in congenital cardiac surgery. The Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery databases contain the elements needed for assessment of quality of care provided that a mechanism exists within these organizations to guarantee the completeness and accuracy of the data. The Central Cardiac Audit Database in the United Kingdom has an advantage in this endeavour with the ability to track and verify mortality independently, through their National Health Service.A combination of site visits with “Source Data Verification”, in other words, verification of the data at the primary source of the data, and external verification of the data from independent databases or registries, such as governmental death registries, may ultimately be required to allow for optimal verification of data. Further research in the area of verification of data is also necessary. Data must be verified for both completeness and accuracy.

Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil

Perfusion ◽  
2021 ◽  
pp. 026765912110204
Author(s):  
Luiz Fernando Caneo ◽  
Gregory S Matte ◽  
Aida Luiza R Turquetto ◽  
Luana Marques de Carvalho Pegollo ◽  
Maria Clara Amato Miglioli ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Outcome Measures ◽  
Myocardial Protection ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Ventricular Dysfunction ◽  
Congenital Heart Surgery ◽  
Cardioplegia Solution ◽  
Congenital Cardiac Surgery ◽  
Reperfusion Period

Objective: The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. Methods: Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas’ solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. Results: Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. Conclusion: In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas’ solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.

Programmatic Changes to Reduce Mortality and Morbidity in Humanitarian Congenital Cardiac Surgery

2018 ◽  
Vol 9 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Tyler J. Wallen ◽  
George J. Arnaoutakis ◽  
Randa Blenden ◽  
Rodrigo Soto
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Ductus Arteriosus ◽  
Reoperation Rate ◽  
Congenital Heart Surgery ◽  
Mortality And Morbidity ◽  
Congenital Cardiac Surgery ◽  
Septal Defects ◽  
Surgical Mission ◽  
Reduction Of Mortality

Background: This report documents the outcomes of cardiac surgical mission trips organized by the International Children's Heart Foundation (ICHF), a nongovernmental organization that provides congenital heart surgery services to the developing world, and discusses factors associated with a reduction of mortality and morbidity in this setting. Methods: A retrospective review of a prospectively maintained database was conducted to identify any patient who underwent surgical intervention during the course of an ICHF mission trip. Results: From 2008 to 2016, a total of 223 trips were made to 23 countries and 3,783 operations were performed. Over 40 unique types of operations were performed with repairs of atrial septal defects (ASDs; n = 479), ventricular septal defects (VSDs; n = 760), teratology of Fallot (n = 473), and ligation of patient ductus arteriosus (PDA; n = 242), comprising the majority of cases. Several organizational policy changes were instituted in 2015. These include the requirement of the host site to have a fully functional blood bank and access to medical subspecialties, the ICHF providing 24-hour intensivist coverage, and not performing surgery on patients weighing less than 10 kg until local capacity has been developed. The overall mortality rate fell to 2.3% from 8.1% after the implementation of these policies. The mortality for ASD repair, VSD repair, PDA ligation, and the repair of tetralogy of Fallot fell from 1.2% to 0%, 1.8% to 0%, 0% to 0%, and 5.6% to 5.1%, respectively. The reoperation rate fell from 11% to 3% and reoperation for a bleeding indication fell from 6% to 2%. Conclusions: Programmatic-level changes have been associated with reduced rates of mortality and morbidity in humanitarian congenital cardiac surgery.

scholarly journals Impact of Cardiac Catheterization on the Outcome of Extracorporeal Membrane Oxygenation (ECMO) After Congenital Cardiac Surgery - Two Centers Experience

2021 ◽  
Author(s):  
Gaser Abdelmohsen ◽  
Jameel Al-Ata ◽  
Naif Alkhushi ◽  
Saud Bahaidarah ◽  
Hysam Baho ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Catheterization ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Ecmo Support ◽  
Congenital Cardiac Surgery ◽  
Membrane Oxygenation ◽  
Successful Weaning

Abstract Background: Cardiac catheterization performed for patients supported by extracorporeal membrane oxygenation (ECMO) after congenital heart surgery may affect their clinical outcome, yet its effect in this group of patients is not adequately studied. The objective of this study was the evaluation of the impact of cardiac catheterization on successful weaning from ECMO support and survival after congenital heart surgery and determining predictors that influence successful weaning. Methods : This is a retrospective cohort study conducted on paediatric patients underwent cardiac catheterization while on ECMO support after congenital heart surgery in two cardiac centres from November 2012 till February 2020. Predictors of successful weaning from ECMO support were studied using univariable and multivariable logistic regression analysis. Results: Out of 141 patients received ECMO support after congenital cardiac surgery,60 patients underwent 60 cardiac catheterizations (31 diagnostic and 29 interventional). The median age was 6.5 months (range 4 days -20 years), median weight was 5 kg (range 2-53 kg). Thirty-four patients (56.7%) underwent successful decannulation from ECMO support and 22patients (36.3%) survived to hospital discharge. Predictors of successful weaning from ECMO support and survival were shorter duration on ECMO support, absence of bleeding tendency, early cardiac catheterization, and biventricular physiology. Conclusion: Cardiac catheterization is feasible with acceptable risks for patients receiving ECMO after congenital heart surgery. The shorter duration on ECMO support may have a significant influence on successful weaning from ECMO and survival after congenital heart surgery. Early cardiac catheterization could also influence the successful weaning from ECMO.

scholarly journals Congenital Cardiac Surgery and Parental Perception of Risk: A Quantitative Analysis

2019 ◽  
Vol 10 (6) ◽  
pp. 669-677
Author(s):  
Robyn Lotto ◽  
Ian Jones ◽  
Sarah E. Seaton ◽  
Ram Dhannapuneni ◽  
Rafael Guerrero ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Risk Scores ◽  
Parental Perception ◽  
Perception Of Risk ◽  
Congenital Cardiac Surgery ◽  
Level Of Agreement ◽  
Over Time

Introduction: Interpretation of risk by parents of children undergoing congenital cardiac surgery is poorly documented. The available evidence highlights a dichotomy where clinicians suggest parents may not grasp the complexity and risk associated with procedures, while some parents suggest risk is unnecessarily overemphasized. Aim: To quantify how risk is perceived by parents. Methods: One hundred six parents of children undergoing cardiac surgery were recruited and completed a Likert-type scale from 1 (perceived low risk) to 6 (perceived high risk), at 5 points: arrival at preadmission, post discussion with anethetist/surgeon, day of surgery, discharge from intensive care, and at outpatient follow-up. The surgical sample was stratified according to Risk Adjustment in Congenital Heart Surgery level. Analysis: Data were analyzed using Wilcoxon rank tests for differences in distributions of scores and Krippendorff α to examine the level of agreement. Results: Median parental risk scores varied over time, with no consistent risk scores observed. Maternal scores were consistently higher than paternal scores at every time point ( P < .001). Postoperative complications resulted in a persistent rise in risk perception at follow-up ( P < .001). Analysis of parental risk scores and objective measures of surgical risk highlighted poor agreement that was particularly marked at the extremes of risk. Conclusions: Parents perceived higher risk scores than those reported by the clinical team. Mothers reported statistically significantly higher scores than their partners, highlighting potential tensions. In addition, the changing perception of risk over time emphasizes the need for flexible levels of support and information as parents navigate uncertainty.

scholarly journals Impact of Patient Characteristics on Hospital-Level Outcomes Assessment in Congenital Heart Surgery

2015 ◽  
Vol 100 (3) ◽  
pp. 1071-1077 ◽  
Author(s):  
Sara K. Pasquali ◽  
Marshall L. Jacobs ◽  
Sean M. O’Brien ◽  
Xia He ◽  
J. William Gaynor ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Outcomes Assessment ◽  
Patient Characteristics ◽  
Congenital Heart Surgery ◽  
Hospital Level

Anemia after Pediatric Congenital Heart Surgery

2021 ◽  
Author(s):  
Kim Anh La ◽  
Camille Jutras ◽  
George Gerardis ◽  
Rachel Richard ◽  
Geneviève Du Pont-Thibodeau
Keyword(s):  
Cardiac Surgery ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Pediatric Intensive Care ◽  
Coarctation Of The Aorta ◽  
Congenital Heart Surgery ◽  
Hypoplastic Left Heart ◽  
Age At Surgery ◽  
Left Heart Syndrome ◽  
Average Hemoglobin

AbstractThe postoperative course of infants following congenital heart surgery is associated with significant blood loss and anemia. Optimal transfusion thresholds for cardiac surgery patients while in pediatric intensive care unit (PICU) remain a subject of debate. The goal of this study is to describe the epidemiology of anemia and the transfusion practices during the PICU stay of infants undergoing congenital heart surgery. A retrospective cohort study was performed in a PICU of a tertiary university-affiliated center. Infants undergoing surgery for congenital heart disease (CDH) before 6 weeks of age between February 2013 and June 2019 and who were subsequently admitted to the PICU were included. We identified 119 eligible patients. Mean age at surgery was 11 ± 7 days. Most common cardiac diagnoses were d-Transposition of the Great Arteries (55%), coarctation of the aorta (12.6%), and tetralogy of Fallot (11.8%). Mean hemoglobin level was 14.3 g/dL prior to surgery versus 12.1 g/dL at the PICU admission. Hemoglobin prior to surgery was systematically higher than hemoglobin at the PICU entry, except in infants with Hypoplastic Left Heart Syndrome. The average hemoglobin at PICU discharge was 11.7 ± 1.9 g/dL. Thirty-three (27.7%) patients were anemic at PICU discharge. Fifty-eight percent of patients received at least one red blood cell (RBC) transfusion during PICU stay. This study is the first to describe the epidemiology of anemia at PICU discharge in infants following cardiac surgery. Blood management of this distinctive and vulnerable population requires further investigation as anemia is a known risk factor for adverse neurodevelopment delays in otherwise healthy young children.

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