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Analysis of factors associated with prolonged post-operative course after surgical repair of aortic coarctation

Published online by Cambridge University Press:  03 November 2020

Santosh Kaipa Open the ORCID record for Santosh Kaipa [Opens in a new window] ,
Mouhammad Yabrodi ,
Brian D. Benneyworth ,
Eric S. Ebenroth  and
Christopher W. Mastropietro
Santosh Kaipa*
Affiliation:
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
Mouhammad Yabrodi
Affiliation:
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
Brian D. Benneyworth
Affiliation:
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
Eric S. Ebenroth
Affiliation:
Department of Pediatrics, Division of Cardiology, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
Christopher W. Mastropietro
Affiliation:
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
*
Author for correspondence: Santosh Kaipa, MD, MS, Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Rm 4911A, Indianapolis, IN 46202, USA. Tel: +1 317 944 1610; Fax: +1 317 944 3442. E-mail: santoshkaipa@gmail.com
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Abstract

Objective:

We sought to describe patient characteristics associated with prolonged post-operative length of stay in a contemporary cohort of infants who underwent isolated repair of aortic coarctation.

Methods:

We reviewed patients less than 1 year of age who underwent isolated repair of aortic coarctation at our institution from 2009 to 2016. Prolonged post-operative length of stay was defined as length of stay within the upper tertile for the cohort. Bivariate and multi-variable analyses were performed to determine independent risk factors for prolonged length of stay.

Results:

We reviewed 95 consecutive patients who underwent isolated repair of aortic coarctation, of whom 71 were neonates at the time of diagnosis. The median post-operative length of stay was 6.5 days. The upper tertile for post-operative length of stay was greater than 10 days; 32 patients within this tertile and 1 patient who died at 8.5 days after surgery were analysed as having prolonged post-operative length of stay. In a multi-variable analysis, pre-maturity (odds ratio: 3.5, 95% confidence interval: 1.2, 10.7), genetic anomalies (odds ratio: 4.7, 95% confidence interval: 1.2, 18), absence of pre-operative oral feeding (odds ratio: 7.4, 95% confidence interval: 2.4, 22.3), and 12-hour vasoactive-ventilation-renal score greater than 25 (odds ratio: 7.4, 95% confidence interval: 1.9, 29) were independently associated with prolonged length of stay.

Conclusions:

In neonates and infants who underwent isolated repair of aortic coarctation, pre-maturity, genetic anomalies, lack of pre-operative oral feedings, and 12-hour vasoactive-ventilation-renal score more than 25 were independent risk factors for prolonged post-operative length of stay. Further study on the relationship between pre-operative oral feedings and post-operative length of stay should be pursued.

Keywords

Aortic coarctationenteral feedinginfantnewbornlength of staypost-operative periodrisk factors
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 191 - 198
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

The results in this manuscript were presented in abstract form at Neoheart 2018, the annual meeting of the Neonatal Heart Society, Fort Worth, TX, March, 2018.

References

Zani, A, Cozzi, DA. Giovanni Battista Morgagni and his contribution to pediatric surgery. J Pediatr Surg 2008; 43: 729–733.CrossRefGoogle Scholar
Crafoord, C, Nylin, G. Congenital coarctation of the aorta and its surgical treatment. J Thoracic Surg 1945; 14: 347–361.CrossRefGoogle Scholar
Torok, RD, Campbell, MJ, Fleming, GA, Kevin, DH. Coarctation of the aorta: management from infancy to adulthood. World J Cardiol 2015; 7: 765–775.CrossRefGoogle Scholar
Kvitting, JE, Olin, CL. Clarence Crafoord: a giant in cardiothoracic surgery, the first to repair aortic coarctation. Ann Thorac Surg 2009; 87: 342–346.CrossRefGoogle ScholarPubMed
Ungerleider, RM, Pasquali, SK, Welke, KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2013; 145:150–158.CrossRefGoogle Scholar
Mery, CM, Guzmán-Pruneda, FA, Trost, JG Jr, et al. Contemporary results of aortic coarctation repair through left thoracotomy. Ann Thorac Surg 2015; 100: 1039–1046.CrossRefGoogle ScholarPubMed
Boston Children’s Hospital Z-Score Calculator. http://zscore.chboston.org/ Google Scholar
Society of Thoracic Surgeons 2015. Congenital Heart Surgery Database Data Specifications Version 3.3. https://www.sts.org/sites/default/files/documents/CongenitalDataSpecsV3_3_Updated.pdf Google Scholar
https://medicine.iu.edu/departments/pediatrics/clinical-care/vasoactive-ventilation-renal-score-calculator Google Scholar
Scherer, B, Moser, EA, Brown, JW, Rodefeld, MD, Turrentine, MW, Mastropietro, CM. Vasoactive-ventilation renal score reliably predicts hospital length of stay after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2016; 152:14231429.CrossRefGoogle ScholarPubMed
Miletic, KG, Delius, RE, Walters, HL III, Mastropietro, CW. Prospective validation of a novel vasoactive-ventilation-renal score as a predictor of outcomes after pediatric cardiac surgery. Ann Thorac Surg 2016; 101: 1558–1563 CrossRefGoogle ScholarPubMed
Cashen, K, Costello, JM, Grimaldi, LM, et al. Multicenter validation of the vasoactive-ventilation-renal score as a predictor of prolonged mechanical ventilation after neonatal cardiac surgery. Pediatr Crit Care Med 2018; 19: 1015–1023.CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
Costello, JM, Pasquali, SK, Jacobs, JP, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014; 129: 2511–2517.CrossRefGoogle Scholar
Steurer, MA, Baer, RJ, Keller, RL, et al. Gestational age and outcomes in critical congenital heart disease. Pediatrics 2017; 140: e20170999.CrossRefGoogle ScholarPubMed
Cnota, JF, Gupta, R, Michelfelder, EC, Ittenbach, RF. Congenital heart disease infant death rates decrease as gestational age advances from 34 to 40 weeks. J Pediatr 2011; 159: 761–765.CrossRefGoogle ScholarPubMed
Anderson, BR, Stevens, KN, Nicolson, SC, et al. Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg 2013; 145: 641–647.CrossRefGoogle ScholarPubMed
Schipper, M, Slieker, MG, Schoof, PH, Breur, JM. Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course. Pediatr Cardiol 2017; 38: 264–270.CrossRefGoogle ScholarPubMed
Simsic, JM, Coleman, K, Maher, KO, Cuadrado, A, Kirshbom, PM. Do neonates with congenital heart disease and genetic abnormalities have increased mortality and morbidity. Congenit Heart Dis 2009; 4: 160–165.CrossRefGoogle Scholar
Gillespie, M, Kuijpers, M, Van Rossem, M, et al. Determinants of intensive care unit length of stay for infants undergoing cardiac surgery. Congenit Heart Dis 2006; 1: 152–160.CrossRefGoogle ScholarPubMed
Iliopoulos, I, Burke, R, Hannan, R, et al. Preoperative intubation and lack of enteral nutrition are associated with prolonged stay after arterial switch operation. Pediatr Cardiol 2016; 37: 1078–1084.CrossRefGoogle ScholarPubMed
Scahill, CJ, Graham, EM, Atz, AM, Bradley, SM, Kavarana, MN, Zyblewski, SC. Preoperative feeding and necrotizing enterocolitis: is the fear justified? World J Pediatr Congenit Heart Surg 2017 8: 62–68.CrossRefGoogle Scholar
Simsic, JM, Carpentino, KR, Kirchner, K, et al. Reducing variation in feeding newborns with congenital heart disease. Congenit Heart Dis 2017; 12: 275–281.CrossRefGoogle ScholarPubMed
Howley, LW, Kaufman, J, Wymore, E, et al. Enteral feeding in neonates with prostaglandin-dependent congenital heart disease: inter-national survey on current trends and variations in practice. Cardiol Young 2012; 22: 121–127.CrossRefGoogle Scholar
Alten, JA, Rhodes, LA, Tabbutt, S, et al. Perioperative feeding management of neonates with CHD: analysis of the Pediatric Cardiac Critical Care Consortium (PC4) Registry. Cardiol Young 2015; 25: 1593–1601.CrossRefGoogle ScholarPubMed
Sables-Baus, S, Kaufman, J, Cook, P, da Cruz, EM. Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery. Cardiol Young 2012; 22: 42–48.CrossRefGoogle ScholarPubMed