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Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: a prospective,
Sarah Tabbutt1, Susan C Nicolson, Troy E Dominguez
1Cardiac Intensive Care Unit, The Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. tabbutt@email.chop.edu
Insights
Pediatric coarctation repair outcomes show younger patients experience longer hospital stays. Older children are more likely to need antihypertensive medication post-discharge, highlighting age-related recovery and management differences.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Clinical Outcomes Research
Background:
- The hospital course following pediatric coarctation repair is not well-documented.
- Understanding factors influencing recovery and discharge is crucial for optimizing patient care.
Purpose of the Study:
- To analyze the impact of age, anatomy, and repair type on aortic crossclamp time.
- To assess the effect of age and crossclamp time on postoperative morbidity.
- To describe current antihypertensive strategies and discharge medication patterns.
Main Methods:
- Data from a prospective multicenter trial of esmolol for coarctation repair (n=118, age < 6 years).
- Analysis of factors influencing aortic crossclamp time and postoperative outcomes.
- Review of antihypertensive regimens used intraoperatively and at discharge.
Main Results:
- Aortic crossclamp time was not affected by patient age or coarctation type.
- Younger age correlated with longer extubation times and hospital stays.
- Esmolol combined with sodium nitroprusside effectively controlled blood pressure.
- 64% of patients received antihypertensives at discharge; older patients were more likely to be discharged on medication.
Conclusions:
- End-to-end anastomosis repair was associated with shorter crossclamp times.
- Younger patients had prolonged hospital stays, indicating age-related recovery differences.
- Combined esmolol and sodium nitroprusside ensured early blood pressure control.
- Older children undergoing coarctation repair require more frequent antihypertensive medication at discharge.
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.
