Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-29T14:11:06.842Z Has data issue: false hasContentIssue false

The effect of clinical and haemodynamic variables on post-operative length of stay immediately upon admission after biventricular repair with Yasui operation following an earlier Norwood operation

Published online by Cambridge University Press:  20 December 2022

Rohit S. Loomba
Affiliation:
Division of Pediatric Cardiac Critical Care, Advocate Children’s Hospital, Oak Lawn, IL, USA Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
Umesh Dyamenahalli
Affiliation:
Division of Pediatric Cardiology, University of Chicago School of Medicine, Chicago, IL, USA
Fabio Savorgnan
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Sebastian Acosta
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Justin J. Elhoff
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Juan S. Farias*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
Enrique Villarreal
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
Saul Flores
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: J. S. Farías MD, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto 3000, Colonia Los Doctores, 64710, Monterrey, Nuevo Leon, Mexico. E-mail: jsfariast@gmail.com

Abstract

Background:

There are a variety of approaches to biventricular repair in neonates and infants with adequately sized ventricles and left-sided obstruction in the presence of a ventricular septal defect. Those who undergo this in a staged manner initially undergo a Norwood procedure followed by a ventricular septal defect closure such that the neo-aorta is entirely committed to the left ventricle and placement of a right ventricular to pulmonary artery conduit (Yasui operation). This study aimed to determine clinical and haemodynamic factors upon paediatric cardiac ICU admission immediately after the two-stage Yasui operation that was associated with post-operative length of stay.

Methods:

This was a retrospective review of patients who underwent the Yasui procedure after the initial Norwood operation between 1 January 2011 and 31 December 2020. Patients with complete data on admission were identified and analysed using Bayesian regression analysis.

Results:

A total of 15 patients were included. The median age was 9.0 months and post-operative length of stay was 6days. Bayesian regression analysis demonstrated that age, weight, heart rate, mean arterial blood pressure, central venous pressure, pulse oximetry, cerebral near infrared spectroscopy, renal near infrared spectroscopy, pH, pCO2, ionised calcium, and serum lactate were all associated with post-operative length of stay.

Conclusion:

Discrete clinical and haemodynamic factors upon paediatric cardiac ICU admission after staged Yasui completion are associated with post-operative length of stay. Clinical target ranges can be developed and seem consistent with the notion that greater systemic oxygen delivery is associated with lower post-operative length of stay.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Yasui, H, Kado, H, Nakano, E, et al. Primary repair of interrupted aortic arch and severe aortic stenosis in neonates. J Thorac Cardiovasc Surg 1987; 93: 539545.10.1016/S0022-5223(19)36381-0CrossRefGoogle ScholarPubMed
Nakano, T, Kado, H, Tatewaki, H, et al. The Yasui operation for patients with adequate-sized ventricles and ventricular septal defect associated with obstructions of the aortic arch and left ventricular outflow tract. Eur J Cardiothorac Surg 2014; 45: e166e172. DOI 10.1093/ejcts/ezt658.10.1093/ejcts/ezt658CrossRefGoogle ScholarPubMed
Carrillo, SA, Mainwaring, RD, Schaffer, JM, et al. Contemporaneous comparison of the Yasui and norwood procedures at a single institution. J Thorac Cardiovasc Surg 2015; 149: 508513. DOI 10.1016/j.jtcvs.2014.09.120.10.1016/j.jtcvs.2014.09.120CrossRefGoogle ScholarPubMed
Kanter, KR, Kirshbom, PM, Kogon, BE. Biventricular repair with the Yasui operation (Norwood/Rastelli) for systemic outflow tract obstruction with two adequate ventricles. Ann Thorac Surg 2012; 93: 19992005. DOI 10.1016/j.athoracsur.2012.02.050 2005.10.1016/j.athoracsur.2012.02.050CrossRefGoogle ScholarPubMed
Hickey, EJ, Yeh, T Jr., Jacobs, JP, et al. Ross and Yasui operations for complex biventricular repair in infants with critical left ventricular outflow tract obstruction. Eur J Cardiothorac Surg 2010; 37: 279288. DOI 10.1016/j.ejcts.2009.06.060.Google ScholarPubMed
Sojak, V, Bokenkamp, R, Kuipers, I, Schneider, A, Hazekamp, M. Biventricular repair after the hybrid norwood procedure. Eur J Cardiothorac Surg 2019; 56: 110116. DOI 10.1093/ejcts/ezz028.10.1093/ejcts/ezz028CrossRefGoogle ScholarPubMed
Andersen, ND, Scherba, JC, Turek, JW. Biventricular conversion in the borderline hypoplastic heart. Curr Cardiol Rep 2020; 22: 115. DOI 10.1007/s11886-020-01363-5.10.1007/s11886-020-01363-5CrossRefGoogle ScholarPubMed
Jacobs, AK, Kushner, FG, Ettinger, SM, et al. ACCF/AHA clinical practice guideline methodology summit report: a report of the american college of cardiology Foundation/American heart association task force on practice guidelines. J Am Coll Cardiol 2013; 61: 213265. DOI 10.1016/j.jacc.2012.09.025.10.1016/j.jacc.2012.09.025CrossRefGoogle Scholar
Saikia, D, Mahanta, B. Cardiovascular and respiratory physiology in children. Indian J Anaesth 2019; 63: 690697. DOI 10.4103/ija.IJA_490_19.10.4103/ija.IJA_490_19CrossRefGoogle ScholarPubMed
Kozik, DJ, Tweddell, JS. Characterizing the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg 2006; 81: S234754. DOI 10.1016/j.athoracsur.2006.02.073.10.1016/j.athoracsur.2006.02.073CrossRefGoogle ScholarPubMed
Loomba, RS, Rausa, J, Sheikholeslami, D, et al. Correlation of Near-Infrared spectroscopy oximetry and corresponding venous oxygen saturations in children with congenital heart disease. Pediatr Cardiol 2022; 43: 197206. DOI 10.1007/s00246-021-02718-7.10.1007/s00246-021-02718-7CrossRefGoogle ScholarPubMed
Hoffman, GM, Ghanayem, NS, Scott, JP, Tweddell, JS, Mitchell, ME, Mussatto, KA. Postoperative cerebral and somatic Near-Infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg 2017; 103: 15271535. DOI 10.1016/j.athoracsur.2016.09.100.10.1016/j.athoracsur.2016.09.100CrossRefGoogle ScholarPubMed
Tweddell, JS, Ghanayem, NS, Mussatto, KA, et al. Mixed venous oxygen saturation monitoring after stage 1 palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2007; 84: 1301–10; discussion 1310-1. DOI 10.1016/j.athoracsur.2007.05.047.10.1016/j.athoracsur.2007.05.047CrossRefGoogle ScholarPubMed
Schranz, D, Schmitt, S, Oelert, H, et al. Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery. Intensive Care Med 1989; 15: 228232. DOI 10.1007/BF00271056.10.1007/BF00271056CrossRefGoogle ScholarPubMed
Hoffman, GM, Scott, JP, Stuth, EA. Effects of arterial carbon dioxide tension on cerebral and somatic regional tissue oxygenation and blood flow in neonates after the norwood procedure with deep hypothermic cardiopulmonary bypass. Front Pediatr 2022; 10: 762739. DOI 10.3389/fped.2022.762739.10.3389/fped.2022.762739CrossRefGoogle ScholarPubMed
Zhang, W, Xie, S, Han, D, Huang, J, Ou-Yang, C, Lu, J. Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair. Cardiol Young 2020; 30: 205212. DOI 10.1017/S1047951119003135.10.1017/S1047951119003135CrossRefGoogle ScholarPubMed
Cheifetz, IM, Kern, FH, Schulman, SR, Greeley, WJ, Ungerleider, RM, Meliones, JN. Serum lactates correlate with mortality after operations for complex congenital heart disease. Ann Thorac Surg 1997; 64: 735738. DOI 10.1016/s0003-497500527-4.10.1016/S0003-4975(97)00527-4CrossRefGoogle ScholarPubMed
Ghaffari, S, Malaki, M. Arterial lactate level changes in first day after cardiac operation. J Cardiovasc Thorac Res 2013; 5: 143145. DOI 10.5681/jcvtr.2013.031.Google ScholarPubMed
Charpie, JR, Dekeon, MK, Goldberg, CS, Mosca, RS, Bove, EL, Kulik, TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000; 120: 7380. DOI 10.1067/mtc.2000.106838.10.1067/mtc.2000.106838CrossRefGoogle ScholarPubMed
Basaran, M, Sever, K, Kafali, E, et al. Serum lactate level has prognostic significance after pediatric cardiac surgery. J Cardiothorac Vasc Anesth 2006; 20: 4347. DOI 10.1053/j.jvca.2004.10.010.10.1053/j.jvca.2004.10.010CrossRefGoogle ScholarPubMed
Sahutoglu, C, Yasar, A, Kocabas, S, Askar, FZ, Ayik, MF, Atay, Y. Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2018; 26: 375385. DOI 10.5606/tgkdc.dergisi.2018.15791.10.5606/tgkdc.dergisi.2018.15791CrossRefGoogle ScholarPubMed
Hatherill, M, Sajjanhar, T, Tibby, SM, et al. Serum lactate as a predictor of mortality after paediatric cardiac surgery. Arch Dis Child 1997; 77: 235238. DOI 10.1136/adc.77.3.235.10.1136/adc.77.3.235CrossRefGoogle ScholarPubMed
Schumacher, KR, Reichel, RA, Vlasic, JR, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2014; 148: 589595. DOI 10.1016/j.jtcvs.2013.09.002.10.1016/j.jtcvs.2013.09.002CrossRefGoogle ScholarPubMed
Ladha, S, Kapoor, PM, Singh, SP, Kiran, U, Chowdhury, UK. The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of fallot. Ann Card Anaesth 2016; 19: 217224. DOI 10.4103/0971-9784.179589.Google ScholarPubMed
Loomba, RS, Flores, S. Oximetry titrated care: this is the way. Paediatr Anaesth 2022; 32: 485485. DOI 10.1111/pan.14350.10.1111/pan.14350CrossRefGoogle ScholarPubMed