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Factors associated with the need for inotropic support following pulmonary artery banding surgery for CHD

Published online by Cambridge University Press:  06 March 2023

Christopher W. Mastropietro Open the ORCID record for Christopher W. Mastropietro [Opens in a new window] ,
Andrea B. Clark ,
Katie L. Loke ,
Paulomi Chaudhry ,
Anne E. Cossu ,
Jyoti K. Patel  and
Jeremy L. Herrmann Open the ORCID record for Jeremy L. Herrmann [Opens in a new window]
Christopher W. Mastropietro*
Affiliation:
Department of Pediatrics, Division of Critical Care, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, USA
Andrea B. Clark
Affiliation:
Riley Hospital for Children at Indiana University Health, Cardiac Data & Outcomes Center, 705 Riley Hospital Drive, Indianapolis, IN, USA
Katie L. Loke
Affiliation:
Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd. Indianapolis, IN, USA
Paulomi Chaudhry
Affiliation:
Department of Pediatrics, Division of Neonatology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, USA
Anne E. Cossu
Affiliation:
Department of Anesthesia, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA Department of Anesthesia, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
Jyoti K. Patel
Affiliation:
Department of Pediatrics, Division of Cardiology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
Jeremy L. Herrmann
Affiliation:
Department of Surgery, Riley Hospital for Children at Indiana University Health, Indiana University, School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: Christopher W. Mastropietro, MD, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN, 46032, USA. Tel: +1 (317) 944 5165. E-mail: cmastrop@iupui.edu
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Abstract

Objective:

We aimed to identify factors independently associated with the need for inotropic support for low cardiac output or haemodynamic instability after pulmonary artery banding surgery for CHD.

Methods:

We performed a retrospective chart review of all neonates and infants who underwent pulmonary banding between January 2016 and June 2019 at our institution. Bivariate and multivariable analyses were performed to identify factors independently associated with the use of post-operative inotropic support, defined as the initiation of inotropic infusion(s) for depressed myocardial function, hypotension, or compromised perfusion within 24 hours of pulmonary artery banding.

Results:

We reviewed 61 patients. Median age at surgery was 10 days (25%,75%:7,30). Cardiac anatomy was biventricular in 38 patients (62%), hypoplastic right ventricle in 14 patients (23%), and hypoplastic left ventricle in 9 patients (15%). Inotropic support was implemented in 30 patients (49%). Baseline characteristics of patients who received inotropic support, including ventricular anatomy and pre-operative ventricular function, were not statistically different from the rest of the cohort. Patients who received inotropic support, however, were exposed to larger cumulative doses of ketamine intraoperatively – median 4.0 mg/kg (25%,75%:2.8,5.9) versus 1.8 mg/kg (25%,75%:0.9,4.5), p < 0.001. In a multivariable model, cumulative ketamine dose greater than 2.5mg/kg was associated with post-operative inotropic support (odds ratio 5.5; 95% confidence interval: 1.7,17.8), independent of total surgery time.

Conclusions:

Inotropic support was administered in approximately half of patients who underwent pulmonary artery banding and more commonly occurred in patients who received higher cumulative doses of ketamine intraoperatively, independent of the duration of surgery.

Keywords

Cardiac surgical proceduresCHDsketaminelow cardiac outputpulmonary artery
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2350 - 2356
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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