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Impact of Preoperative Functional Capacity on Postoperative Outcomes in Congenital Heart Surgery: An Observational
Angela Sachiko Inoue1, Antônio Augusto Barbosa Lopes1, Ana Cristina Sayuri Tanaka1
1Universidade de São Paulo Hospital das Clínicas,São Paulo, SP - Brasil.
Insights
Preoperative oxygen saturation after the 6-minute walk test (6MWT) predicts outcomes in pediatric congenital heart surgery. This vital sign, unlike walked distance or heart rate variability (HRV), is a key indicator for postoperative complications.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Cardiovascular morbidity remains high in children and adolescents with congenital heart disease, despite surgical advances.
- Postoperative complications like cardiogenic and septic shock, and death, significantly impact patient outcomes.
Purpose of the Study:
- To assess the link between preoperative cardiovascular fitness (6-minute walk test (6MWT) and Heart Rate Variability (HRV)) and postoperative complications in pediatric patients.
- To identify predictors of adverse events following congenital heart surgery.
Main Methods:
- Prospective observational study of 81 pediatric patients (8-18 years) undergoing congenital heart surgery.
- Preoperative assessment included the 6-minute walk test (6MWT) measuring distance walked and SpO2, and Heart Rate Variability (HRV).
- Surgical risk was evaluated using the RACHS-1 score; combined events included cardiogenic shock, septic shock, or death.
Main Results:
- The study included 59% males, mean age 12 years; 33% were cyanotic, and 72% had prior cardiac surgery.
- Cardiogenic shock was the most frequent complication, with 31% experiencing a combined event.
- Postoperative SpO2 recovery after the 6MWT emerged as an independent risk factor (OR 0.93, p=0.02) for combined events.
Conclusions:
- Preoperative SpO2 levels following the 6-minute walk test are an independent predictor of prognosis in pediatric patients undergoing surgical correction for congenital heart disease.
- Walked distance during the 6MWT and Heart Rate Variability (HRV) did not show a significant association with postoperative outcomes.
Background:
Despite advances in surgical technique and postoperative care in congenital heart disease, cardiovascular morbidity is still high.
Objective:
To evaluate the association between preoperative cardiovascular fitness of children and adolescents, measured by the 6-minute walk test (6MWT) and Heart Rate Variability (HRV), and the occurrence of cardiogenic, septic shock and death in the postoperative period.
Methods:
Prospective, observational clinic study including 81 patients aged from 8 to 18 years. In the preoperative period, the 6MWT (distance walked and SpO2) and HRV were performed. The adjusted risk score for surgeries for congenital heart disease (RACHS-1) was applied to predict the surgical risk factor for mortality. The occurrence of at least one of the listed complications was considered as a combined event. P values < 0.05 were considered as significant.
Results:
Of the patients, 59% were male, with mean age of 12 years; 33% were cyanotic; and 72% had undergone previous cardiac surgery. Cardiogenic shock was the most common complication, and 31% had a combined event. Prior to surgery, type of current heart disease, RACHS-1, SpO2at rest, during the 6MWT and recovery were selected for the multivariate analysis. The SpO2at recovery by the 6MWT remained as an independent risk factor (OR 0.93, 95%CI [0.88 - 0.99], p=0.02) for the increasing occurrence of combined events.
Conclusion:
SpO2after the application of the 6MWT in the preoperative period was an independent predictor of prognosis in children and adolescents undergoing surgical correction; the walked distance and the HRV did not present this association.
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