Persistent Liver Dysfunction in Pediatric Patients After Total Cavopulmonary Connection Surgery.

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.