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Cardiac Function Decline After General Anesthesia and Cardiac Catheterization in Pediatric Cardiac Transplant
Gokul Thimmarayan1, Michael Schmitz1, Beverly J Spray2
1Departments of Anesthesiology and Pain Medicine, Section of Pediatric Cardiac Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, US.
Seminars in Cardiothoracic and Vascular Anesthesia
|December 2, 2024
Summary
Cardiac function decline occurs in 25% of pediatric heart transplant patients during general anesthesia for procedures. Older age, ACE inhibitor use, and elevated right ventricular end diastolic pressure predict this decline.
Area of Science:
- Pediatric Cardiology
- Anesthesiology
- Transplant Medicine
Background:
- Pediatric cardiac transplant recipients often undergo procedures like cardiac catheterization and endomyocardial biopsy (CC/EMB) under general anesthesia (GA).
- General anesthesia and positive pressure ventilation (PPV) can depress cardiac function, potentially confounding graft assessment.
- The study investigates the impact of GA/PPV on cardiac function in these patients.
Purpose of the Study:
- To determine the frequency of cardiac function decline from the awake to the anesthetized state in pediatric heart transplant recipients.
- To identify patient-related and anesthetic factors associated with this cardiac function decline.
Main Methods:
- Retrospective review of electronic medical records for pediatric heart transplant recipients undergoing CC/EMB under GA/PPV.
- Inclusion criteria: awake normal cardiac function (left ventricular shortening fraction [LVSF] ≥28%) assessed pre-procedure.
- Cardiac function decline defined as post-procedure LVSF <28%.
Main Results:
- Cardiac function decline occurred in 17.3% of encounters and 25% of patients.
- Independent predictors of decline included older age (OR 1.4), angiotensin-converting enzyme inhibitor (ACEI) use (OR 2.5), and elevated right ventricular end diastolic pressure (RVEDP) (OR 2.4).
- Older age correlated with both ACEI use and elevated RVEDP.
Conclusions:
- Approximately one in four pediatric heart transplant patients experience cardiac function decline when transitioning from awake to anesthetized states.
- This decline is most prevalent in older children with elevated RVEDP who are using ACE inhibitors.
- The observed cardiac function declines are generally not attributable to graft rejection.
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