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Interventions Associated With Treatment of Low Cardiac Output After Stage 1 Norwood Palliation. Ann Thorac Surg 2021 05;111(5):1620-1627

Date

07/12/2020

Pubmed ID

32652068

DOI

10.1016/j.athoracsur.2020.05.068

Scopus ID

2-s2.0-85095846624   7 Citations

Abstract

BACKGROUND: Mortality after stage 1 palliation of hypoplastic left heart syndrome remains significant. Both cardiac output (CO) and systemic vascular resistance (SVR) contribute to hemodynamic vulnerability. Simultaneous measures of mean arterial pressure and somatic regional near infrared spectroscopy saturation can classify complex hemodynamics into 4 distinct states, with a low-CO state of higher risk. We sought to identify interventions associated with low-CO state occupancy and transition.

METHODS: Perioperative data were prospectively collected in an institutional review board-approved database. Hemodynamic state was classified as high CO, high SVR, low SVR, and low CO using bivariate analysis. Associations of static and dynamic support levels and state classifications over 48 postoperative hours were tested between states and across transitions using mixed regression methods in a quasi-experimental design.

RESULTS: Data from 10,272 hours in 214 patients were analyzed. A low-CO state was observed in 142 patients for 1107 hours. Both low CO and extracorporeal membrane oxygenation had increased mortality risk. The low-CO state was characterized by lower milrinone but higher catecholamine dose. Successful transition out of low CO was associated with increased milrinone dose and hemoglobin concentration. Increasing milrinone and hemoglobin levels predicted reduced risk of low CO in future states.

CONCLUSIONS: Bivariate classification objectively defines hemodynamic states and transitions with distinct support profiles. Maintaining or increasing inodilator and hemoglobin levels were associated with improved hemodynamic conditions and were predictive of successful future transitions from the low-CO state.

Author List

Hoffman GM, Niebler RA, Scott JP, Bertrandt RA, Wakeham MK, Thompson NE, Ghanayem NS, Stuth EA, Mitchell ME, Woods RK, Hraska V, Mussatto KA, Tweddell JS

Authors

Rebecca Ann Bertrandt MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Viktor Hraska MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Michael Edward Mitchell MD Professor in the Surgery department at Medical College of Wisconsin
Robert Niebler MD Professor in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD Professor in the Anesthesiology department at Medical College of Wisconsin
Eckehard A. Stuth MD Professor in the Anesthesiology department at Medical College of Wisconsin
Nathan Thompson MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Martin K. Wakeham MD Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin




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

Cardiac Output, Low
Female
Hemodynamics
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Male
Norwood Procedures
Postoperative Complications
Retrospective Studies