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Published on: November 28, 2018
Prognostic value of cardiac cycle efficiency in children undergoing cardiac surgery: a prospective observational
Ding Han1, Shoudong Pan1, Hang Li2
1Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China.
Insights
Cardiac cycle efficiency (CCE) in children undergoing heart surgery varies by diagnosis. Lower CCE predicts worse outcomes, including longer ICU stays and increased need for inotropics.
Area of Science:
- Pediatric Cardiac Surgery
- Hemodynamics
- Energetic Efficiency
Background:
- Cardiac cycle efficiency (CCE) offers a unique energetic perspective on hemodynamic performance.
- Assessing CCE changes based on anatomical diagnosis is crucial for pediatric cardiac surgery patients.
Purpose of the Study:
- To investigate how CCE changes across different anatomical diagnoses in children undergoing cardiac surgery.
- To determine the association between CCE and early postoperative outcomes.
Main Methods:
- Ninety children with VSD, TOF, or TAPVC were studied.
- CCE was monitored from anesthesia induction to 48 hours post-surgery.
- Predictive CCE (CCEp) was used to compare high vs. low CCEp groups regarding postoperative outcomes.
Main Results:
- A significant interaction between time and diagnostic group affected CCE trends.
- The low CCEp group (n=22) experienced more inotropics, higher lactate levels, longer intubation, and longer ICU stays compared to the high CCEp group (n=23).
Conclusions:
- Perioperative CCE dynamics differ based on anatomical diagnosis in pediatric cardiac surgery.
- Tetralogy of Fallot (TOF) patients showed an unfavorable CCE trend compared to VSD and TAPVC.
- Decreased CCE correlates with adverse early postoperative outcomes.
Background:
Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery.
Methods:
Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile).
Results:
There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid.
Conclusions:
Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes.
Clinical Trial Registration:
ChiCTR1800014996.
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