The Year in Review: Anesthesia for Congenital Heart Disease 2021

Abstract

This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).

2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers

“…4 However, children with CHD that contracted COVID-19 experienced longer hospital length of stay (22 vs 6 days), higher complication rates (6.9 vs 1.1%) and higher mortality (3.8 vs 0.8%). 4 Patients with previous heart transplants also showed both a higher prevalence of infection (18 vs 7 cases per 1,000) and higher fatality rate (29.7 vs 15.4%) when compared to the general population. 4 It was also noted that heart transplant patients have a muted response to vaccination with only 15% of patients showing positive antibody titers after their first dose and 49% after the second.…”

“…4 The effects of prior COVID-19 infection were also highlighted, citing an article that found no difference in adverse outcomes after surgery in children who had previously recovered from COVID-19 infection, but significantly higher mortality rate (46%) in children who were infected during the post-operative period. 4…”

“…The authors point out a study where surgeons provided a bleeding score every hour and compared this to simultaneous ROTEM measurements, severe bleeding correlated with abnormal ROTEM results only 58.3% of the time. 4 Another recent study evaluated the ability of TEG to predict post-CPB bleeding, particularly the maximum amplitude (MA) value. This study demonstrated good correlation between the MA value (using a cutoff of 45 mm) during rewarming and the need for blood product transfusion, recombinant factor VIIa use, and the need for surgical re-exploration.…”

“…4 Other investigators attempted to validate its use by performing a retrospective case-controlled study of 31 pediatric patients and found that platelet function tests were not significantly different between patients that experienced bleeding and those that did not. 4 Finally, multiplate, multiple impedance platelet aggregometry was compared to ROTEM and no significant difference was found between in the tests in their ability to predict which patients would require a platelet transfusion, however, they did show an association between platelet transfusion and the maximum clot firmness (MCF) seen on ROTEM. 4 Guidelines from professional societies offer weak recommendations for the use of point of care viscoelastic testing in the interoperative and post-operative periods to guide transfusion decisions.…”

“…4 The effects of prior COVID-19 infection were also highlighted, citing an article that found no difference in adverse outcomes after surgery in children who had previously recovered from COVID-19 infection, but significantly higher mortality rate (46%) in children who were infected during the postoperative period. 4 Pediatric mechanical aortic valve replacement, though initially successful, has been shown to impact duration and quality of life--often requiring additional cardiac surgery for subsequent complications. Advances in aortic valve repair are highlighted from a group in Melbourne that exhibited better long-term outcomes utilizing initial surgical aortic valve repair and recommend this in lieu of transcatheter procedures in the neonatal and infant population.…”