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Cardiac performance and mortality early after intracardiac surgery in infants and young children
Insights
Post-intracardiac surgery in young children, low cardiac index (CI) and mixed venous oxygen partial pressure (P-vO2) predict acute cardiac failure deaths. Maintaining CI > 2.0 and P-vO2 > 30 mmHg is crucial for survival.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Outcomes
- Critical Care Medicine
Background:
- Intracardiac surgery in infants and young children (<48 months) carries significant mortality risk, primarily due to acute cardiac failure.
- Understanding hemodynamic parameters is crucial for managing these vulnerable patients post-operatively.
Purpose of the Study:
- To investigate the relationship between hemodynamic parameters and mortality in pediatric patients following intracardiac surgery.
- To identify key indicators for predicting acute cardiac failure and guide therapeutic interventions.
Main Methods:
- Studied 139 infants and children (<48 months) within 72 hours of intracardiac surgery.
- Monitored cardiac index (CI), mixed venous oxygen partial pressure (P-vO2), mean arterial pressure, and systemic vascular resistance.
- Analyzed correlations between hemodynamic parameters, age, and hospital mortality, focusing on causes of death.
Main Results:
- Hospital mortality was 19.4%, with 16 deaths attributed to acute cardiac failure.
- Low cardiac index (CI) and low mixed venous oxygen partial pressure (P-vO2) were strongly associated with cardiac deaths.
- CI and P-vO2 together provided a more reliable prediction of acute cardiac death than either parameter alone.
- Adequate CI and P-vO2 levels were not dependent on patient age but rather on the specific cardiac malformation.
Conclusions:
- Treatment strategies should aim to maintain cardiac index (CI) > 2.0 L/min/m² and mixed venous oxygen partial pressure (P-vO2) > 30 mmHg.
- Reducing left ventricular afterload may be beneficial in select patients.
- The underlying cardiac malformation is a key determinant of hemodynamic stability, not patient age.
Abstract:
One hundred thirty-nine infants and small children less than 48 months old were studied during the first 72 hours after intracardiac surgery for a variety of lesions. The hospital mortality rate was 19.4% (27 patients); 16 of those dying succumbed from acute cardiac failure. Deaths from acute cardiac failure were commonest in patients with low cardiac index (CI), and a continuous probability curve relates the two. The mean CI for all patients was 2.51 plus or minus 0.794 l-min minus 1-m minus 2, and that for individual patients varied between 0.6 and 4.9. Cardiac output normalized by surface area (cardiac index) correlated weakly with age. cardiac output normalized by weight did not correlate with age; Mean mixed venous oxygen partial pressure (P-vO2)varied between 17 and 60 mm Hg, and the weighted mean for the group of 80 patients in whom it was obtained was 33.1 plus or minus 6.57 mm Hg. CI and P-vO2 were only slightly related. Acute cardiac deaths occurred more frequently in patients with low P-vO2. Acute cardiac death was more reliably predicted using CI and P-vO2 together than either alone. The average of the mean arterial pressure was 80.5 plus or minus 2.53 mm Hg, and this did not correlate with CI. Mean average systemic vascular resistance was 30.0 plus or minus 8.395 SRU. We conclude that in such patients treatment should be directed toward keeping CI greater than 2.0 l-min minus 1-m minus 2 and P-vO2 greater than 30 mm Hg; that the possibility of maintaining adequate CI and P-vO2 is not related to the age of the patient but is related to the malformation treated; and that a therapeutic trial of reducing left ventricular afterload is indicated in some of these patients.