Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-16T10:57:58.483Z Has data issue: false hasContentIssue false

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*
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

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.

Type
Original Article
Copyright
© The Author(s), 2023. 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

Chandler, HK, Kirsch, R. Management of the low cardiac output syndrome following surgery for congenital heart disease. Curr Cardiol Rev 2016; 12: 107111.10.2174/1573403X12666151119164647CrossRefGoogle ScholarPubMed
Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 22262235.10.1161/01.CIR.92.8.2226CrossRefGoogle ScholarPubMed
Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 9961002.10.1161/01.CIR.0000051365.81920.28CrossRefGoogle ScholarPubMed
Cavigelli-Brunner, A, Hug, MI, Dave, H, et al. Prevention of low cardiac output syndrome after pediatric cardiac surgery: a double-blind randomized clinical pilot study comparing dobutamine and milrinone. Pediatr Crit Care Med 2018; 19: 619625.10.1097/PCC.0000000000001533CrossRefGoogle ScholarPubMed
Sharma, R. Pulmonary artery banding: rationale and possible indications in the current era. Ann Pediatr Cardiol 2012; 5: 4043.10.4103/0974-2069.93709CrossRefGoogle ScholarPubMed
Angeli, E, Pace Napoleone, C, Turci, S, Oppido, G, Gargiulo, G. Pulmonary artery banding. Multimed Man Cardiothorac Surg 2012; 2012: mms010.Google ScholarPubMed
Wernovsky, G, Giglia, TM, Jonas, RA, Mone, SM, Colan, SD, Wessel, DL. Course in the intensive care unit after ‘preparatory’ pulmonary artery banding and aortopulmonary shunt placement for transposition of the great arteries with low left ventricular pressure. Circulation 1992; 86.Google ScholarPubMed
Li, J, Zhang, G, Benson, L, et al. Comparison of the profiles of postoperative systemic hemodynamics and oxygen transport in neonates after the hybrid or the norwood procedure: a pilot study. Circulation 2007; 116[suppl I]: I179I187.10.1161/CIRCULATIONAHA.106.679654CrossRefGoogle ScholarPubMed
Loomba, RS, Gray, SB, Flores, S. Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension. Congenit Heart Dis 2018; 13: 646654.10.1111/chd.12662CrossRefGoogle ScholarPubMed
Morray, JP, Lynn, AM, Stamm, SJ, Herndon, PS, Kawabori, I, Stevenson, JG. Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg 1984; 63: 895899.10.1213/00000539-198410000-00004CrossRefGoogle ScholarPubMed
Oklü, E, Bulutcu, FS, Yalçin, Y, Ozbek, U, Cakali, E, Bayindir, O. Which anesthetic agent alters the hemodynamic status during pediatric catheterization? Comparison of propofol versus ketamine. J Cardiothorac Vasc Anesth. 2003; 17: 686690.10.1053/j.jvca.2003.09.009CrossRefGoogle ScholarPubMed
Sungur Ulke, Z, Kartal, U, Orhan Sungur, M, Camci, E, Tugrul, M. Comparison of sevoflurane and ketamine for anesthetic induction in children with congenital heart disease. Paediatr Anaesth 2008; 18: 715721.10.1111/j.1460-9592.2008.02637.xCrossRefGoogle ScholarPubMed
Gaies, MG, Jeffries, HE, Niebler, RA, et al. Vasoactive-inotropic score (VIS) is associated with outcome after infant cardiac surgery: an analysis from the pediatric cardiac critical care consortium (PC4) and virtual PICU system registries. Pediatr Crit Care Med 2014; 15: 529537.10.1097/PCC.0000000000000153CrossRefGoogle Scholar
Han, D, Liu, YG, Pan, S, Luo, Y, Li, J, Ou-Yang, C. Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect: a prospective, randomized research. Medicine (Baltimore) 2017; 96: e9039.10.1097/MD.0000000000009039CrossRefGoogle ScholarPubMed
Sprung, J, Schuetz, SM, Stewart, RW, Moravec, CS. Effects of ketamine on the contractility of failing and nonfailing human heart muscles in vitro. Anesthesiology 1998; 88: 12021210.10.1097/00000542-199805000-00010CrossRefGoogle ScholarPubMed