Improvement in perioperative care in pediatric cardiac surgery by shifting the primary focus of treatment from cardiac output to perfusion pressure: Are beta stimulants still needed?

Hosseinpour, Amir-Reza; Steenberghe, Mathieu van; Bernath, Marc-André; Bernardo, Stefano Di; Perez, Marie-Hélène; Longchamp, David; Dolci, Mirko; Boegli, Yann; Sekarski, Nicole; Orrit, Javier; Hurni, Michel; Prêtre, René; Cotting, Jacques

doi:10.1111/chd.12485

Cited by 7 publications

(11 citation statements)

References 41 publications

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“…Through comparion of two groups of open and closed heart surgery, significant association was found during twice after surgery, hence frequency of hypomagnesaemia in patients who had undergone closed surgery was higher at first hour after operation while no significant relationship was observed between two groups on second day and interestingly hypomagnesaemia was significantly higher in open surgery group. Bearing in mind that the sole perioperative recommended magnesium was through cardioplegia solution, this is important particularly in comparing with other researches 7,8. Therefore, it could be concluded that some other pre and post-operative metabolic issues in addition to cardiopulmonary bypass should be involved in postoperative hypomagnesaemia.…”

Section: Discussionmentioning

confidence: 95%

Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery

et al. 2019

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Objective and Background: During the past decade, many researchers have indicated that open cardiac surgery, using cardiopulmonary bypass, could be an essential factor to induce post-operative electrolyte imbalances which may be followed by life threatening complications such as arrhythmia. Nevertheless, by this time there may be a few researches about comparing of hypomagnesaemia and other electrolyte imbalances between open, on pump, and closed, off pump, heart operation. Methods: In this cohort study conducted at Rajaie Heart Center in Tehran from December 2014 to August 2015, we evaluated hypomagnesaemia, hypocalcemia, hypokalemia and hyponatremia in 205 children aged under 15 years who underwent open (101 children) and closed (104 children) cardiac surgery. Repeated measures ANOVA, paired t test and Chi-square/Fisher exact test were used for analysis the data in SPSS version 21. Results: According to our study the frequency of electrolyte imbalances including hypomagnesaemia after pediatric heart surgery is relatively high (28.7% hypomagnesaemia at the second day) with more occurrence in closed cardiac operations. There was no significant relationship between hypomagnesaemia and pump time duration (P>0.05). On the other hand, this research indicated that there is significant relationship between post-operative hypomagnesaemia and some other variables including cyanotic heart disease (P=0.01) and concurrent electrolyte imbalance such as hypocalcaemia and hypokalemia (P<0.05). Conclusion: Early evaluation and correction of hypomagnesaemia should be considered after both closed and open heart operation. How to cite this:Shahidi M, Bakhshandeh H, Rahmani K, Afkhamzadeh A. Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.367 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 95%

Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery

et al. 2019

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“…30 Optimising perfusion pressure instead of focusing on maximising CO, by favouring low-dose dopamine agonists and lusitropic agents (milrinone) has been shown to improve mortality and reduce ventilation times in paediatric cardiac surgery patients. 31 Fenestration improves CO at times of high PVR by allowing diversion of blood from the "bottle-neck" of the circuit to the heart. 30 More research into short-term benefits of fenestration is needed as whilst it also reduces PAP and reduces the risk of PPE, a recent meta-analysis suggests no significant difference in intrahospital mortality and LOS compared to nonfenestrated patients.…”

Section: Circulationmentioning

confidence: 99%

Perioperative and long-term management of Fontan patients

et al. 2021

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A Fontan circulation requires a series of three-staged operations aimed to palliate patients with single-ventricle CHD. Currently, the most frequent technique is the extracardiac total cavopulmonary connection, an external conduit connecting the IVC and right pulmonary artery, bypassing the right side of the heart. Fontan candidates must meet strict criteria; they are assessed utilising both cardiac catheterisation and cardiac magnetic resonance. Postoperatively, treatment protocols prioritise antibiotic prophylaxis, diuretics, angiotensin-converting enzyme inhibitors, anticoagulation, and oxygen therapy with fluid restriction and a low-fat diet. These measures aim to reduce length of stay in the ICU and hospital by preventing acute complications such as infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury. Late complications of a Fontan procedure include circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease. The definitive management is cardiac transplantation, with promising innovations in selective embolisation of lymphatic vessels and Fontan-specific ventricular assist devices. Further research assessing current protocols in the perioperative management of Fontan patients would be beneficial for standardising current practice and improving outcomes.

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“…The quality of evidence (GRADE) was very low (three studies included and evaluated this outcome among the eight and high risk of bias). II°) Perioperative lactate levels: 9 studies in cardiac surgery were included for meta-analysis (6 observational prospective and 3 observational retrospective) [19][20][21][22][23][24][30][31][32]. II.1°) Mortality (Supplemental Figure 7): 9 trials (6 prospective and 3 retrospective) with 1690 children in cardiac surgery were included for this outcome.…”

Section: Effects Of Interventions I°)mentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

2019

J Emerg Med Crit Care

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Introduction:In adults, studies have shown that when goal directed fluid and haemodynamic therapy was applied in the perioperative period, morbi-mortality was reduced. In children the impact on postoperative outcome of this therapy is not clear.Objective: To determine the impact of intraoperative goal directed fluid and haemodynamic therapy on postoperative morbimortality in children less than 18 years old.Methods: Systematic review and meta-analysis of randomised and non randomised studies.RevMan 5.3 sofware was used for statistic analysis.Results: 23 studies were included with 3389 children among which 21 trials concerned cardiac surgical children and two concerned non cardiac patients: 1° In 3290 children in 21 studies included, mortality was significantly lower in the experimental group (the group with higher above baseline values of regional oxygen saturation, of mixed central venous oxygen saturation, and lower lactate levels) (odds ratio=0.03 [0.01, 0.14], p<0.00001). The quality of evidence (GRADE) was low.2° In 14 studies with 2347 children included, organ dysfunction was significantly lower in the experimental group (odds ratio = 0.02 [0.00, 0.08], p <0.00001). The quality of evidence (GRADE) was low.3° in 8 studies length of hospital stay was significantly lower in the experimental group (p=0.018). The quality of evidence (GRADE) was very low. Conclusions:Intraoperative goal directed fluid and haemodynamic therapy is not developed in children, there are biomarkers of postoperative adverse outcome in pediatric cardiac surgery.Research is to be developed in children to clarify the impact of goal directed fluid and hemodynamic therapy on postoperative outcome.

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Improvement in perioperative care in pediatric cardiac surgery by shifting the primary focus of treatment from cardiac output to perfusion pressure: Are beta stimulants still needed?

Cited by 7 publications

References 41 publications

Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery

Hypomagnesaemia and other electrolytes imbalances in open and closed pediatrics cardiac surgery

Perioperative and long-term management of Fontan patients

A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

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