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Nonlinear Relationship Between Coronary Perfusion Pressure and In-Hospital Outcomes After Infant Congenital Heart
Tongkai Ge1,2, Dandong Luo1, Qiuji Wang2
1Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Insights
Postoperative coronary perfusion pressure (CPP) in infants undergoing congenital cardiac surgery shows a U-shaped relationship with poor in-hospital outcomes. Both low and high CPP levels are linked to prolonged recovery, highlighting the importance of optimal CPP management.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Congenital cardiac surgery in infants requires careful hemodynamic management.
- Postoperative coronary perfusion pressure (CPP) is a critical indicator of myocardial perfusion.
- Understanding the relationship between CPP and in-hospital outcomes is vital for improving patient care.
Purpose of the Study:
- To evaluate the association between postoperative coronary perfusion pressure (CPP) and in-hospital outcomes in infants following congenital cardiac surgery.
- To determine if CPP levels correlate with adverse outcomes such as prolonged recovery.
Main Methods:
- Retrospective analysis of 208 infants undergoing congenital cardiac surgery.
- Logistic regression and restricted cubic splines (RCSs) were used to analyze the association between CPP and outcomes.
- Primary outcome was prolonged recovery, defined by extended hospital stay, mechanical ventilation, or ICU stay.
Main Results:
- A U-shaped relationship was observed between CPP levels and poor in-hospital outcomes.
- Both low CPP (<47 mm Hg) and high CPP (>47 mm Hg) were significantly associated with prolonged recovery.
- Mortality rate was 1%, with significant associations for prolonged recovery with both low and high CPP levels.
Conclusions:
- Postoperative CPP in infants undergoing congenital cardiac surgery exhibits a nonlinear, U-shaped association with poor in-hospital outcomes.
- Maintaining CPP within an optimal range is crucial for minimizing prolonged recovery and improving outcomes.
- Further research may focus on specific CPP targets for different surgical complexities.
Objectives:
Our goal was to evaluate the associations between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants after congenital cardiac surgery. Our goal was to assess the relationship between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants following congenital cardiac surgery.
Methods:
In this study, we conducted a retrospective analysis on a cohort of 296 consecutive infant patients (aged 31-120 days) who underwent congenital cardiac surgery between 1 January 2019 and 30 April 2019. A total of 208 patients undergoing congenital cardiac surgery were included. The primary poor in-hospital outcome was prolonged recovery. The association between CPP level and in-hospital outcomes was determined using logistic regression analysis. We also used restricted cubic splines (RCSs) to evaluate the nonlinear relationship.
Results:
Our study included 208 participants, among whom the mortality rate was 1%. Prolonged hospital length of stay (LOS) was defined as more than 15 days, prolonged mechanical ventilation (MV) stay as more than 96 h, and prolonged intensive care unit (ICU) LOS as more than 403 h. In univariate analyses, we found that prolonged recovery was associated with both low CPP levels (p < 0.001, OR 4.28, 95% CI 1.94-9.46) and high CPP levels (p = 0.003, OR 3.39, 95% CI 1.52-7.58). In multivariable logistic regression analysis, after full adjustment, low CPP levels and high CPP levels were significantly associated with prolonged recovery (p = 0.005, OR = 3.72, 95% CI 1.48-9.35 and p < 0.001, OR = 6.04, 95% CI 2.32-15.72, respectively). We observed that the relationship between CPP level and poor in-hospital outcomes was U-shaped in a two-piecewise linear regression analysis. We found that the inflection point of CPP level for prolonged recovery was 47 mm Hg.
Conclusion:
The CPP levels exhibited a nonlinear relationship with poor in-hospital outcomes.
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