Faculty Collaboration Database

Mixed venous oxygen saturation monitoring after stage 1 palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2007 Oct;84(4):1301-10; discussion 1310-1

Date

09/25/2007

Pubmed ID

17888987

DOI

10.1016/j.athoracsur.2007.05.047

Scopus ID

2-s2.0-34548661975 (requires institutional sign-in at Scopus site)   132 Citations

Abstract

BACKGROUND: Staged palliation for hypoplastic left heart syndrome has been marked by high early mortality due to the limited cardiac output of the postischemic single right ventricle combined with the inefficiency and volatility of parallel circulation.

METHODS: Since July 1996, we have performed stage 1 palliation (S1P) in 178 patients. Within this group is a consecutive cohort of 116 patients with true hypoplastic left heart syndrome that underwent S1P with a modified Blalock-Taussig shunt. A prospective database containing postoperative hemodynamic data was maintained on all patients. Studied were the incidence of organ failure, extracorporeal membrane oxygenation (ECMO), and mortality, as well as the relationship between these outcomes and postoperative hemodynamics.

RESULTS: Hospital survival for this cohort was 93% (108/116). Patients who died after S1P had a lower superior vena cava oxygen saturation (SVO2) level compared with survivors (53.1% +/-10.6% versus 59.3% +/-9.2%, p = 0.034). Renal failure developed in 2 (1.7%) of the 116 patients, necrotizing enterocolitis developed in 1 (0.9%), and 5 (4.3%) had clinical seizures. ECMO support was instituted in 12 patients (10.3%). The SVO2 level was lower in patients requiring ECMO (54.0% +/- 9.7% versus 59.9% +/- 9.2%, p = 0.031).

CONCLUSIONS: Goal-directed therapy with SVO2 as an indicator of systemic oxygen delivery is associated with excellent early survival and a low incidence of organ failure after S1P. Inability to optimize SVO2 in the early postoperative period is associated with an increased risk of organ failure, ECMO, and death.

Author List

Tweddell JS, Ghanayem NS, Mussatto KA, Mitchell ME, Lamers LJ, Musa NL, Berger S, Litwin SB, Hoffman GM

Authors

George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering

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

Cardiac Surgical Procedures
Cause of Death
Cohort Studies
Female
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Male
Monitoring, Physiologic
Multivariate Analysis
Oximetry
Oxygen Consumption
Palliative Care
Postoperative Care
Probability
Retrospective Studies
Risk Assessment
Survival Analysis
Vena Cava, Superior