Abstract
Background: Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to ensure the effective volume of systemic circulation by maintaining an appropriate pressure gradient between the systemic vein and the left atrium. However, there is a lack of effective indexes to evaluate volume responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is to validate the sensitivity and specificity of SVV vs. central venous pressure (CVP) in assessing volume responsiveness of Fontan patients.Method: 64 children were included in this prospective study with single-ventricle who underwent modified Fontan operation between May 2018 and January 2020. Patients were given 10ml·kg− 1 albumin for volume challenge within 10 min after CPB. Before and after volume challenge, the invasive arterial pressure module was connected to Mostcare™ equipment to collect SBP, MBP, DBP, SVV, CI and SVRI dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with ΔCI ≥ 15% were classified into response (R) group and patients with ΔCI < 15% into non-response (NR) group. Using SVV and CVP as indicators, the ROC of the patients was established, and the AUC, diagnostic threshold, sensitivity and specificity were calculated.Results: The 64 pediatric patients included with a mean age of 4.85 ± 1.20 years, a mean height of 98.00 ± 16.74 cm and a mean weight of 15.65 ± 5.37 kg. The SVV value was 17.15 ± 3.97% and 13.45 ± 2.45% before and after fluid challenge treatment vs. 18.60 ± 1.83 mmHg and 20.20 ± 2.39 mmHg for CVP in responders. The AUC of SVV was 0.74 (95% confidence interval [CI] 0.54–0.94, P < 0.05) and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7% vs.0.70 (95% CI 0.50–0.92, P > 0.05), 19.5 mmHg, 58% and 76% for CVP.Conclusion: SVV exhibited a good predictive value for volume responsiveness in pediatric Fontan patients. Appropriate volume therapy according to SVV could improve the cardiac function of such patients.Trial registration: This research was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654.Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035)
Monitoring of central venous pressure and stroke volume variation in a case with a ruptured brain arteriovenous malformation and Fontan circulation
