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Evaluation of perioperative risk factors in pediatric patients with left ventricle outflow tract obstruction
Canan Salman Önemli1, Kübra Evren Şahin1, Mustafa Karaçelik2
1Department of Anesthesiology and Reanimation, Saglik Bilimleri University, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
Insights
Identifying perioperative risk factors is crucial for preventing complications in pediatric patients undergoing surgery for left ventricular outflow tract obstruction (LVOTO). Preoperative neutrophil-to-lymphocyte ratio (NLR) and postoperative lab values can predict adverse outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Left ventricular outflow tract obstruction (LVOTO) is a complex pediatric cardiac condition often associated with other anomalies.
- Postoperative complications following pediatric cardiac surgery for LVOTO can be life-threatening, necessitating identification of risk factors.
- Understanding perioperative risk factors allows anesthesiologists and surgeons to implement preventive measures.
Purpose of the Study:
- To evaluate perioperative risk factors associated with postoperative complications in pediatric patients undergoing surgery for LVOTO.
- To identify specific clinical and laboratory markers that predict adverse outcomes.
- To inform strategies for improving patient safety and outcomes in this population.
Main Methods:
- Retrospective analysis of 58 pediatric patients operated on for LVOTO.
- Patients categorized into groups with and without postoperative complications.
- Data collected included preoperative and postoperative laboratory results, surgical times, and clinical outcomes.
Main Results:
- Endocrine and hepatic complications were most common postoperatively.
- Higher preoperative lymphocyte counts and lower neutrophil-to-lymphocyte ratio (NLR) were associated with complications.
- Postoperative differences observed in pH, glucose, creatinine, AST, and calcium levels; lower intraoperative platelet transfusion rate in the complication group.
Conclusions:
- Identifying predictive factors is critical for preventing complications in pediatric LVOTO surgery.
- Preoperative NLR, intraoperative platelet transfusion, and specific postoperative lab values (calcium, glucose, pH, AST) may aid in complication prediction.
- These findings can guide clinical decision-making and risk stratification.
Introduction:
Left ventricular outflow tract obstructions (LVOTO) presents as complex cardiac diseases accompanied by other cardiac anomalies in the pediatric age group. Postoperative complications, especially cardiac, pulmonary, and renal complications, that may develop after pediatric cardiac surgery can become life-threatening. If the perioperative risk factors for these complications are known in pediatric patients with LVOTO, anesthesiologists and surgeons may take precautions to eliminate undesirable outcomes.
Aim:
To evaluate the perioperative risk factors that may contribute to the development of postoperative complications in pediatric patients operated on for LVOTO in a pediatric cardiac surgery clinic.
Material And Methods:
The study retrospectively investigated 58 patients who were operated on for LVOTO in a pediatric cardiac surgery clinic. The patients were divided into two groups, those with and without postoperative complications. Preoperative laboratory test results, anesthesia time, operation time, aortic cross-clamp time, cardiopulmonary bypass (CPB) time, postoperative inotropes, first postoperative laboratory tests, intraoperative and postoperative complications, mechanical ventilation time, intensive care unit stay, and hospital stay were recorded.
Results:
The most common postoperative complications were endocrine complications, followed by hepatic complications. The preoperative lymphocyte count was significantly higher (p < 0.05), and the neutrophil-to-lymphocyte ratio (NLR) was significantly lower (p < 0.05) in the group with postoperative complications. The postoperative pH, glucose, creatinine, and aspartate aminotransferase (AST) levels were significantly lower (p < 0.05), and the postoperative calcium level was significantly higher (p < 0.05) in the group without postoperative complications. Intraoperative platelet transfusion rate was found to be significantly lower (p < 0.05) in the group with postoperative complications.
Conclusions:
It is critical to identify predictive factors to prevent postoperative complications in pediatric patients undergoing surgery for LVOTO. Preoperative NLR, intraoperative platelet transfusion, and postoperative calcium, glucose, pH and AST levels may help in the prediction of complications.
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