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[ANALYSIS OF THE POSTOPERATIVE COURSE OF COMPLEX CONGENITAL HEART DISEASES SIMULTANEOUS CORRECTION WITH AN OPEN
Insights
Delayed sternum closure is a viable option for infants with complex congenital heart defects (CHD). High blood lactate and low mean arterial pressure (MAP) are key predictors of adverse outcomes in these pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects (CHD)
- Thoracic Surgery Techniques
Context:
- Delayed sternum closure is a critical intervention for infants undergoing complex congenital heart defect (CHD) correction.
- This technique aims to improve cardiac output in the early postoperative period.
- Understanding associated risks and outcomes is vital for optimizing patient care.
Purpose:
- To evaluate the mortality rates associated with delayed sternum closure in pediatric patients with CHD.
- To identify predictors of adverse outcomes, including noncardiac complications.
- To assess the safety and efficacy of this surgical approach in neonates and infants.
Summary:
- A prospective cohort study of 22 infants undergoing complex CHD correction utilized delayed sternum closure.
- Mortality was observed in 6 patients; key adverse outcome predictors included mean arterial pressure (MAP) < 35 mmHg and elevated blood lactate levels (> 10 mmol/l).
- The study highlights delayed sternum closure as an acceptable method for managing cardiac output post-surgery, with specific physiological parameters indicating risk.
Impact:
- Provides critical insights into managing complex congenital heart defects (CHD) in neonates and infants.
- Identifies specific physiological markers (MAP, lactate) for early risk stratification and intervention.
- Informs clinical decision-making regarding sternum closure timing in high-risk pediatric cardiac surgery cases.
Unlabelled:
In children during the first months of life delayed sternum closure is one of the few techniques increasing cardiac output after simultaneous correction of complex congenital heart defects (CHD). The aim of study was evaluating mortality, predictors of adverse outcome and frequency noncardial complications at of delayed sternum closure after correction of CHD.
Methods:
Study design: a prospective, uncontrolled, cohort. 22 children were studied 6 children died. Anesthesia was carried out on the basis ofpropofol (3 mg/kg/h) and fentanyl (5 pg/kg/h) infusion with sevoflurane inhalation in a dose of 1-1.5 WT, including during perfusion. Cardiopulmonary bypass (IR) was carried out by the "Stockert S50" using oxygenators ("Medtronic"). After IR in all cases the use of arterio--venous modified ultrafiltration. Sternum closure was performed on average 2.7 ± 1.4 days after surgery.
Results:
The odds ratio (OR) of death development at the mean arterial pressure (MAP) < 35 Hg was 3.7, the OR for the risk of death development if SVO₂ < 40% was 0.94. OR for risk of death when blood lactate level > 10 mmol/l during the first three days ofpostoperative intensive care was 2.1.
Conclusions:
The technique of delayed sternum closure is an acceptable method of maintaining cardiac output in children during the first months of life with CHD in the postoperative period. High blood lactate level (> 10 mmol/l) and especially its further growth and the MAP < 35 mm Hg can be predictors of adverse outcomes of surgical interventions with an open sternotomy.
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