Predictors of In-Hospital Mortality in Isolated Total Anomalous Pulmonary Venous Connection

Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome. Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included. Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardiac output syndrome (OR: 1.060; 95% CI: 1.008-1.116) and prolonged postoperative mechanical ventilation (OR: 1.772; 95% CI: 1.141-2.751) were independent factors of in-hospital mortality. Conclusion: Surgical repair of TAPVC is now performed with acceptable results. According to our study, postoperative low cardiac output syndrome and prolonged postoperative mechanical ventilation were the most significant predictors for early mortality.

Download Full-text

Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003728 ◽

2021 ◽

Vol 134 (4) ◽

pp. 552-561

Author(s):

Ryan M. Hijazi ◽

Daniel I. Sessler ◽

Chen Liang ◽

Fabio A. Rodriguez-Patarroyo ◽

Edward G. Soltesz ◽

...

Keyword(s):

Cardiac Output ◽

Coronary Artery ◽

Hospital Mortality ◽

Artery Bypass ◽

Valve Surgery ◽

Bypass Grafting ◽

Composite Outcome ◽

Aortic Valve Surgery ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

Background Recent work suggests that having aortic valve surgery in the morning increases risk for cardiac-related complications. This study therefore explored whether mortality and cardiac complications, specifically low cardiac output syndrome, differ for morning and afternoon cardiac surgeries. Methods The study included adults who had aortic and/or mitral valve repair/replacement and/or coronary artery bypass grafting from 2011 to 2018. The components of the in-hospital composite outcome were in-hospital mortality and low cardiac output syndrome, defined by requirement for at least two inotropic agents at 24 to 48 h postoperatively or need for mechanical circulatory support. Patients who had aortic cross-clamping between 8 and 11 am (morning surgery) versus between 2 and 5 pm (afternoon surgery) were compared on the incidence of the composite outcome. Results Among 9,734 qualifying operations, 0.4% (29 of 6,859) died after morning, and 0.7% (20 of 2,875) died after afternoon surgery. The composite of in-hospital mortality and low cardiac output syndrome occurred in 2.8% (195 of 6,859) of morning patients and 3.4% (97 of 2,875) of afternoon patients: morning versus afternoon confounder-adjusted odds ratio, 0.96 (95% CI, 0.75 to 1.24; P = 0.770). There was no evidence of interaction between morning versus afternoon and surgery type (P = 0.965), and operation time was statistically nonsignificant for surgery subgroups. Conclusions Patients having aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting with aortic cross-clamping in the morning and afternoon did not have significantly different outcomes. No evidence was found to suggest that morning or afternoon surgical timing alters postoperative risk. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2018-19-5-676-687 ◽

2018 ◽

Vol 19 (5) ◽

pp. 676-687

Author(s):

G.G. Khubulava ◽

A.B. Naumov ◽

S.P. Marchenko ◽

O.Yu. Chupaeva ◽

A.A. Seliverstova ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

Download Full-text

Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

Annals of Intensive Care ◽

10.1186/s13613-021-00808-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Rafael Alves Franco ◽

Juliano Pinheiro de Almeida ◽

Giovanni Landoni ◽

Thomas W. L. Scheeren ◽

Filomena Regina Barbosa Gomes Galas ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Prolonged Mechanical Ventilation ◽

Kidney Injury ◽

Composite Endpoint ◽

Tissue Perfusion ◽

Hospital Length Of Stay ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Noninferiority Trial

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

Download Full-text