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Critical care outcomes in pulmonary atresia and intact ventricular septum undergoing single-ventricle palliation

Published online by Cambridge University Press:  22 March 2010

Mark A. Walsh ,
Kentaro Asoh ,
Glen S. Van Arsdell  and
Tilman Humpl
Mark A. Walsh
Affiliation:
Division of Cardiology, Department of Paediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Kentaro Asoh
Affiliation:
Division of Cardiology, Department of Paediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Glen S. Van Arsdell
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Tilman Humpl*
Affiliation:
Division of Cardiology, Department of Paediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Division of Cardiac Critical Care Medicine, Department of Critical Care Medicine, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
*
Correspondence to: Tilman Humpl, MD, Division of Cardiac Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Tel: +1 416 813 6477; Fax: +1 416 813 7299; E-mail: tilman.humpl@sickkids.ca
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Abstract

Objective

To examine early outcomes for pulmonary atresia with intact ventricular septum undergoing single-ventricle palliation and to determine risk factors for mortality.

Design

Retrospective observational study.

Setting

Tertiary paediatric critical care unit.

Intervention

Risk factors for mortality were sought for infants after the primary intervention whether surgical shunt or ductal stent.

Measurements and main results

We reviewed outcomes of 19 infants with pulmonary atresia with intact ventricular septum undergoing single-ventricle palliation between July, 2000 and July, 2008. Echocardiograms, cardiac catheterisation findings, anaesthesia, and critical care management, as well as autopsy reports were reviewed. We modelled survival after surgery and looked for predictors of early mortality. A total of 19 infants underwent single-ventricle palliation and seven of these died. The risk of death was increased by a lower arterial pH at induction of anaesthesia (p = 0.01), a lower systolic blood pressure (p = 0.01), and technical problems during surgery (p = 0.03). On admission to the critical care unit, a lower mixed venous saturation (p = 0.02) and presence of tachyarrhythmia (p = 0.02) were associated with the need for mechanical support within the first 48 hours.

Conclusions

There is a high early mortality for those who undergo single-ventricle palliation. It is higher for those who are haemodynamically compromised before surgery; technical problems, and haemodynamic instability during surgery also increase mortality.

Keywords

Cardiac defectscongenitalright ventricular coronary circulationsingle-ventricle palliationcardiac critical care
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 3 , June 2010 , pp. 290 - 296
Copyright
Copyright © Cambridge University Press 2010

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