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Impact of early postoperative haemodynamic and laboratory parameters on outcome after the Fontan procedure

Published online by Cambridge University Press:  29 January 2024

Chiara Di Padua
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Takuya Osawa
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Birgit Waschulzik
Affiliation:
School of Medicine, Institute of AI and Informatics in Medicine, Technische Universität München, Munich, Germany
Gunter Balling
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Thibault Schaeffer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Helena Staehler
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Nicole Piber
Affiliation:
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
Alfred Hager
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Peter Ewert
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Jürgen Hörer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Masamichi Ono*
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
*
Corresponding author: M. Ono; Email: ono@dhm.mhn.de

Abstract

Objective:

To identify early postoperative haemodynamic and laboratory parameters predicting outcomes following total cavopulmonary connection.

Methods:

Patients who underwent total cavopulmonary connection between 2012 and 2021 were evaluated. Serial values of mean pulmonary artery pressure, mean arterial pressure, peripheral oxygen saturation, and lactate levels were collected. The influence of these variables on morbidities was analyzed. Cut-off values were calculated using the receiver operating characteristic analysis.

Results:

A total of 249 patients were included. All patients had previous bidirectional cavopulmonary shunt. Median age and weight at total cavopulmonary connection were 2.2 (1.8–2.7) years and 11.7 (10.7–13.4) kg, respectively. All patients were extubated in the ICU at a median of 3 (2–5) hours after ICU admission. Postoperative pulmonary artery pressure, around 12 hours after extubation, was significantly associated with chest tube drainage (p = 0.048), chylothorax (p = 0.021), ascites (p = 0.016), and adverse events (p = 0.028). Receiver operating characteristic analysis revealed a cut-off value of 13–15 mmHg for chest tube drainage and chylothorax and 17 mmHg for ascites and adverse events. Mean arterial pressure 1 hour after extubation was associated with prolonged chest tube drainage (p = 0.015) and adverse events (p = 0.008). Peripheral oxygen saturation 6 hours after extubation (p = 0.003) was associated with chest tube duration and peripheral oxygen saturation 1 hour after extubation (p < 0.001) was associated with ascites. Lactate levels on 2nd postoperative day (p = 0.022) were associated with ascites and lactate levels on 1st postoperative day (p = 0.009) were associated with adverse events.

Conclusions:

Higher pulmonary artery pressure, lower mean arterial pressure, lower peripheral oxygen saturation, and higher lactate in early postoperative period, around 12 hours after extubation, predicted in-hospital and post-discharge adverse events following total cavopulmonary connection.

Type
Original Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

de Leval, MR, Kilner, P, Gewillig, M, Bull, C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 1988; 96: 682695.CrossRefGoogle ScholarPubMed
Pridjian, AK, Mendelsohn, AM, Lupinetti, FM, et al. Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 1993; 71: 959962.CrossRefGoogle ScholarPubMed
van der Ven, JPG, van den Bosch, E, Bogers, AJCC, Helbing, WA. State of the art of the Fontan strategy for treatment of univentricular heart disease. F1000Res 2018; 7: 935.Google ScholarPubMed
Ono, M, Kasnar-Samprec, J, Hager, A, et al. Clinical outcome following total cavopulmonary connection: a 20-year single-centre experience. Eur J CarioThorac Surg 2016; 50: 632641.CrossRefGoogle ScholarPubMed
Cao, JY, Marathe, SP, Zannino, D, et al. Fontan operation at less than 3 years of age is not a risk factor for long-term failure. Eur J Cardiothorac Surg 2022; 61: 497504.CrossRefGoogle Scholar
Dowing, TE, Allen, KY, Glatz, AC, et al. Long-term survival after the Fontan operation: twenty years of experience at a single center. J Thorac Cardiovasc Surg 2017; 154: 243253.CrossRefGoogle Scholar
Nakano, T, Kado, H, Tatewaki, H, et al. Results of extracardiac conduit total cavopulmonary connection in 500 patients. Eur J Cardiothorac Surg 2015; 48: 825832.CrossRefGoogle ScholarPubMed
d’Udekem, Y, Iyengar, AJ, Galati, JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014; 130: S328.Google ScholarPubMed
Rogers, L, Glatz, AC, Ravishankar, C, et al. 18 years of the Fontan operation at a single institution. J Am Coll Cardiol 2012; 60: 10181025.CrossRefGoogle ScholarPubMed
Sharma, VJ, Iyengar, AJ, Zannino, D, et al. Protein-losing enteropathy and plastic bronchitis after the Fontan procedure. J Thorac Cardiovasc Surg 2021; 161: 21582165.CrossRefGoogle ScholarPubMed
Caruthers, RL, Kempa, M, Loo, A, et al. Demographic characteristics and estimated prevalence of Fontan-associated plastic bronchitis. Pediatr Cardiol 2013; 34: 256261.CrossRefGoogle ScholarPubMed
Lo Rito, M, Al-Radi, OO, Saedi, A, et al. Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion. J Thorac Cardiovasc Surg 2018; 155: 20682077.CrossRefGoogle ScholarPubMed
Kaulitz, R, Ziemer, G, Luhmer, I, Kallfelz, HC. Modified Fontan operation in functionally univentricular hearts: preoperative risk factors and intermediate results. J Thorac Cardiovasc Surg 1996; 112: 658664.CrossRefGoogle ScholarPubMed
Ono, M, Cleuziou, J, Pabst von Ohain, J, et al. Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: impact of valve morphology and underlying mechanisms on survival and reintervention. J Thorac Cardiovasc Surg 2018; 155: 701709.CrossRefGoogle ScholarPubMed
Hosein, RB, Clarke, AJ, McGuirk, SP, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The ‘two commandments’? Eur J CarioThorac Surg 2007; 31: 344353.CrossRefGoogle ScholarPubMed
Ono, M, Georgiev, S, Burri, M, et al. Early extubation improves outcome following extracardiac total cavopulmonary connection. Interact Cardiovasc Thorac Surg 2019; 29: 8592.Google ScholarPubMed
Hothorn, T, Hornik, K, Zeileis, A. Unbiased recursive partitioning: a conditional inference framework. J Comput Graph Stat 2006; 15: 651674.CrossRefGoogle Scholar
Ohuchi, H, Miyazaki, A, Negishi, J, et al. Hemodynamic determinants of mortality after Fontan operation. Am Heart J 2017; 189: 918.CrossRefGoogle ScholarPubMed
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