Faculty Collaboration Database

Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: a prospective, multicenter experience. J Thorac Cardiovasc Surg 2008 Nov;136(5):1229-36

Date

11/26/2008

Pubmed ID

19026808

DOI

10.1016/j.jtcvs.2008.06.035

Scopus ID

2-s2.0-56249105396 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

OBJECTIVE: The hospital course for pediatric coarctation repair has not been described. We had 4 aims: (1) to determine the influence of age, anatomy, and type of repair on aortic crossclamp time, (2) to determine the impact of age or aortic crossclamp time on postoperative morbidity, (3) to describe current antihypertensive strategies, and (4) to describe antihypertensive medications at hospital discharge.

METHODS: Data were obtained from a prospective randomized multicenter esmolol safety and efficacy trial. The study included patients who were scheduled for a coarctation repair receiving esmolol as their first-line antihypertensive medication in the operating room (n = 118; weight > or = 2.5 kg and age < 6 years).

RESULTS: (1) Patient age and type of coarctation did not affect the aortic crossclamp time. (2) Younger age, but not aortic crossclamp time, was associated with a significantly longer time to extubation and longer hospital length of stay. (3) A combination of esmolol and sodium nitroprusside (Nipride, Roche, Basel, Switzerland) provided excellent early blood pressure control. (4) At discharge, 64% of patients were receiving antihypertensive medications. Older patients were more likely to be discharged with antihypertensive medication (91% of patients aged 2-6 years, P < .0002).

CONCLUSION: The study describes a multi-institutional approach to the repair of isolated coarctation in infants and children. Patients repaired by end-to-end anastomosis had shorter aortic crossclamp time, younger patients had longer hospital length of stay, a majority of patients had sodium nitroprusside (Nipride) added to esmolol for early blood pressure control, and older patients were more likely to be discharged with antihypertensive medication.

Author List

Tabbutt S, Nicolson SC, Dominguez TE, Wells W, Backer CL, Tweddell JS, Bokesch P, Schreiner M

MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Age Factors
Antihypertensive Agents
Aortic Coarctation
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Length of Stay
Male
Nitroprusside
Propanolamines
Prospective Studies
Thoracotomy