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Persistent Liver Dysfunction in Pediatric Patients After Total Cavopulmonary Connection Surgery
Qipeng Luo1, Yuan Jia2, Zhanhao Su3
1Pain Medicine Center, Peking University Third Hospital, Peking University Health Science Center, Beijing, China.
Insights
Aortic cross-clamping and elevated postoperative central venous pressure are key risk factors for persistent liver dysfunction after pediatric cardiac surgery. Monitoring CVP is crucial for preventing prolonged recovery and increased costs.
Area of Science:
- Cardiology
- Hepatology
- Pediatric Surgery
Background:
- Early liver dysfunction (LD) post-cardiac surgery is linked to mortality.
- Persistent LD after total cavopulmonary connection (TCPC) surgery requires further investigation into risk factors.
Purpose of the Study:
- To identify risk factors for persistent liver dysfunction following TCPC surgery in pediatric patients.
- To assess the predictive value of central venous pressure (CVP) for persistent LD.
Main Methods:
- Retrospective case-control study design.
- Defined persistent LD (POD1-7, sustained on POD7) and transient LD (POD1-7, recovered by POD7).
- Utilized multivariable logistic regression, analyzing CVP continuously and in quantiles.
Main Results:
- 111 patients (27.1%) experienced postoperative LD; 46 (11.2%) had persistent LD.
- Aortic cross-clamping (ACC) and elevated postoperative CVP were significant risk factors for persistent LD.
- Increased CVP levels (14-16 mmHg and >16 mmHg) correlated with substantially higher odds of persistent LD.
Conclusions:
- Intra-operative ACC and elevated postoperative CVP are independent risk factors for persistent LD post-TCPC.
- Persistent LD is associated with longer mechanical ventilation, hospital stay, and higher costs.
- Close monitoring of postoperative CVP is recommended to prevent persistent LD.
Background:
Studies have reported early liver dysfunction (LD) after cardiac surgery is associated with short and long-term mortality. In this study, we aimed to investigate risk factors for persistent LD after total cavopulmonary connection (TCPC) surgery.
Methods:
This is a retrospective case-control study. We defined persistent LD as LDs occurring between postoperative day 1 (POD1) and POD7 and sustaining at least on POD7, while transient LD as LDs occurring between POD1 and POD7 and recovering at least on POD7. Multivariable logistic regression analysis was applied and central venous pressure (CVP) was considered continuously or in quantiles.
Results:
Postoperative LD occurred in 111 (27.1%) patients. Transient and persistent LD occurred in 65 (15.9%) and 46 (11.2%) patients, respectively. Aortic cross-clamping (ACC) (odds ratio [OR] 2.55, 95% CI 1.26-5.14) and postoperative CVP (OR 1.34, 95% CI 1.18-1.51) were risk factors for persistent LD, also identified for postoperative any LD and transient LD. Adding postoperative CVP to the model only including ACC significantly improved persistent LD prediction (△AUC 0.15, p = 0.002). Compared with CVP ≤ 14 mmHg, adjusted ORs and 95% CI of persistent LD for CVP of 14-16 and >16 mmHg were 3.11 (1.24, 7.81) and 10.55 (3.72, 29.93), respectively. Patients with persistent LD might have a longer length of mechanical ventilation (mean difference, 13.5 h) and postoperative hospital stay (mean difference, 7 days), and higher postoperative costs (mean difference, 6.7 thousand dollars) compared to those with transient LD.
Conclusions:
Intra-operative application of ACC and postoperative elevated CVP were independent risk factors for persistent LD in pediatric patients following TCPC surgery. Compared to patients with transient LD, patients with persistent LD might have a longer length of mechanical ventilation and postoperative hospital stay, and higher postoperative costs. We should pay more attention to patients with high postoperative CVP to prevent their persistent LD occurrence.
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