Postoperative management of heart failure in pediatric patients

Yuerek, Mahsun; Rossano, Joseph W.; Mascio, Christopher E.; Shaddy, Robert E.

doi:10.1586/14779072.2016.1117388

Cited by 16 publications

(12 citation statements)

References 135 publications

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“…It has also been suggested that neutrophil interactions with other myocardial inflammatory cells after acute MI may result in myocardial dysfunction [21]. Although the mechanism of myocardial damage is different in our study population, there are known deleterious effects on the myocardium resulting from cardiac operation and CPB, which contribute to postoperative low cardiac output syndrome [23]. It is feasible that the negative sequelae attributed to neutrophil migration in adult patients after MI could be extrapolated to our study population and that patients with a higher neutrophil count preoperatively may thus be at increased risk of adverse outcomes.…”

Section: Neutrophiliamentioning

confidence: 74%

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

Jones

McCracken

Alsoufi

et al. 2018

The Annals of Thoracic Surgery

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In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.

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Section: Neutrophiliamentioning

confidence: 74%

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

Jones

McCracken

Alsoufi

et al. 2018

The Annals of Thoracic Surgery

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“…Low cardiac output syndrome (LCOS) is the most common complication following cardiac surgeries. The incidence of LCOS in the surgical treatment of congenital heart disease (CHD) has been reported to be 25-60% [1], associated with a significant risk of mortality among patients [2,3]. LCOS is associated with a decreased ejection fraction and decreased oxygen supply, which may cause hypoxia.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study

Chen

Song

et al. 2020

BMC Pediatr

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Background: Low cardiac output syndrome (LCOS) is an important complication of cardiac surgery. It is associated with increased morbidity and mortality. The incidence of LCOS after surgery is high in patients with congenital heart disease (CHD). Therefore, determining the risk factors of LCOS has clinical significance for the management of CHD. This study aimed to analyze the risk factors of LCOS. Methods: We conducted a retrospective analysis of children with CHD who underwent cardiac surgery at Shanghai Children's Medical Center between January 1, 2014, and December 31, 2017. Demographic characteristics and baseline data were extracted from the health data resource center of the hospital, which integrates clinical routine data including medical records, diagnoses, orders, surgeries, laboratory tests, imaging, nursing, and other subsystems. Logistic regressions were performed to analyze the risk factors of LCOS. Results: Overall, 8660 infants with CHD were included, and 864 (9.98%) had LCOS after surgery. The multivariate regression analysis identified that age (OR 0.992, 95% CI: 0.988-0.997, p = 0.001), tricuspid regurgitation (1.192, 1.072-1.326, p = 0.001), Risk Adjustment in Congenital Heart Surgery-1 risk grade (1.166, 1.011-1.345, p = 0.035), aortic shunt (left-to-right: 1.37, 1.005-1.867, p = 0.046; bi-directional: 1.716, 1.138-2.587, p = 0.01), atrial shunt (left-toright: 1.407, 1.097-1.805, p = 0.007; right-to-left: 3.168, 1.944-5.163, p < 0.001; bi-directional: 1.87, 1.389-2.519, p < 0.001), ventricular level shunt (left-to-right: 0.676, 0.486-0.94, p = 0.02; bi-directional: 2.09, 1.611-2.712, p < 0.001), residual shunt (3.489, 1.502-8.105, p = 0.004), left ventricular outflow tract obstruction (3.934, 1.673-9.254, p = 0.002), right ventricular outflow tract obstruction (3.638, 1.225-10.798, p = 0.02), circulating temperature (mild hypothermia: 1.526, 95% CI: 1.205-1.934, p < 0.001; middle and low temperature: 1.738, 1.236-2.443, p = 0.001), duration of cardiopulmonary bypass (1.009, 1.006-1.012, p < 0.001), myocardial preservation using histidine-tryptophanketoglutarate (1.677, 1.298-2.167, p < 0.001), and mitral insufficiency (1.714, 1.239-2.37, p < 0.001) were independent risk predictors of LCOS. Conclusions: The incidence of postoperative LCOS in CHD children remains high. Circulation temperature, myocardial preservation using histidine-tryptophan-ketoglutarate, and usage of residual shunt after surgery were independent risk predictors for LCOS.

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“…Interestingly, for patients undergoing the Fontan procedure, transpulmonary gradient and chest tube drainage were significantly lower in the vasopressin group compared to placebo [47] . Norepinephrine has been used for patients with LCOS and low systemic vascular resistance, but less commonly than epinephrine and vasopressin [48] . Finally, in a recent review of the PHIS database by Loomba and Flores [15] , while the use of catecholaminergic inotropes and vasopressors after cardiac surgery have decreased over the past ten years, the use of vasopressin has increased.…”

Section: Vasopressin and Norepinephrinementioning

confidence: 99%

Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use

Sahulee¹,

McKinstry²

2022

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The low cardiac output syndrome describes the phenomenon of the reduction of cardiac output that can occur following cardiac surgery requiring cardiopulmonary bypass. If unrecognized or untreated, this condition can result in significant morbidity and mortality. Along with non-pharmacologic therapies, pharmacologic agents used to help manage the low cardiac output syndrome include catecholamine inotropes, inodilators, systemic vasodilators, pulmonary vasodilators, and other classes of medications. We summarize the rationale and key evidence supporting the use of these therapies in children. In addition, utilizing provider surveys and registry reviews, we describe the current trends in the use of these medications and the variation demonstrated between providers and centers. Given the heterogeneous etiology of low cardiac output syndrome, successful management requires that pharmacologic therapies be tailored to the physiologic derangements of each patient.

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Postoperative management of heart failure in pediatric patients

Cited by 16 publications

References 135 publications

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study

Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use

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