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Routine Perioperative Esmolol After Infant Tetralogy of Fallot Repair: Single-Center Retrospective Study of

Jeremy T Affolter1,2, Andrew Well1,3, Erin A Gottlieb1,3

  • 1Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|October 6, 2022
PubMed

Insights

Routine postoperative esmolol in infants undergoing tetralogy of Fallot (TOF) repair was associated with stable hemodynamics and minimal vasoactive support. This approach demonstrated no 30-day mortality in the studied cohort.

Area of Science:

  • Pediatric Cardiac Surgery
  • Cardiovascular Anesthesiology
  • Pediatric Critical Care

Background:

  • Tetralogy of Fallot (TOF) repair carries a significant mortality risk, particularly in infants with junctional ectopic tachycardia (JET) or restrictive right ventricular physiology.
  • Current postoperative management often includes adrenergic or inodilator therapy, but the role of beta-blockade post-cardiopulmonary bypass remains less defined.
  • This study addresses the gap by evaluating the routine use of esmolol in infants following TOF repair.

Approach:

  • A retrospective chart review was conducted on pediatric patients (<18 months) undergoing TOF repair at a single institution between June 2018 and April 2021.
  • Patients receiving perioperative esmolol were identified, and their postoperative hemodynamic parameters, vasoactive support requirements, and clinical outcomes were analyzed.
  • Exclusion criteria included TOF with absent pulmonary valve or atrioventricular septal defect.

Key Points:

  • Twenty-six infants received perioperative esmolol following TOF repair.
  • Most patients exhibited stable postoperative hemodynamics with minimal need for vasoactive medications.
  • Three patients developed JET, and one experienced a transient cardiac arrest; however, no 30-day or 1-year mortality was observed.
  • Median hospital and postoperative length of stay were 7 and 6 days, respectively.

Conclusions:

  • Routine perioperative esmolol administration in infants undergoing TOF repair appears safe and effective, promoting good cardiac output and reducing the need for intensive vasoactive support.
  • This strategy, as part of a multidisciplinary approach, may enhance the optimal postoperative management of these complex pediatric cardiac surgical cases.
  • The findings suggest that esmolol can be a valuable component in the postoperative care of infants after tetralogy of Fallot repair.
Abstract

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