THE RISK FACTORS FOR POSTOPERATIVE OUTCOMES IN NEONATAL CARDIAC SURGERY

  • Hristina Mandzukovska University Clinic for Pediatric Diseases, Intensive Care Unit,Faculty of Medicine, Ss Cyril and Methodius University,Skopje,R. North Macedonia

Abstract

In the last three decades a neonatal cardiac surgery has improved the aproach and methods for adequate treatment of complex congenital heart defects. Although we have advances in fetal cardiac imaging and improved perioperative cardiac procedures, the postoperative outcomes in neonates are still present. We present our experience of operated neonates with congenital heart defects in a tertiary referral center, University Clinic for Pediatric Diseases, Neonatal Intensive Care Unit (NICU) in Skopje N. Macedonia. This is a retrospective study including neonates who underwent surgical intervention between January 2013 and December 2015. We analyzed perioperative and postoperative variables, duration of cardiopulmonaly bypass (CPB),  and x-cross of aorta, duration of mechanical ventilation, intensive care unit stay and postoperative complications. Out of a total of 85 children, 15/85 (17.6 %) were neonates; the overall mortality was 1/15% (6.6%).There were 13/15 (86.6%) corrective procedures and 2/15 (13.3%) palliative ones. The mean duration of CPB was 46.6 min.,  duration of x-cross of aorta was 17.5 min. The mean duration of mechanical ventilation was 3.4 days, duration of inotropic support was 4.2 days, and ICU stay 5.8 days. Postoperative complications were confirmed in 3 neonates. Due to adequate cardiac surgery, signicant technological advances, devices and increasing experience in neonatal cardiac surgery we have improved  postoperative outcomes.


Keywords: cardiac surgery, neonates, cardiopulmonaly bypass, inotropic support.


https://doi.org/10.55302/JMS2141034m


 


 


 

References

1. Oppido G, Pace Napoleone C, Formigari R, et al. Outcome of cardiac surgery in low birth weight and premature infants. Eur J CardiothoracSurg2004;26:44–53.
2. Chang AC, Hanley FL, Lock JE, Castaneda AR, Wessel DL.Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr1994;124:461–6.
3. Reddy VM, McElhinney DB, Sagrado T, Parry AJ, Teitel DF, Hanley FL. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg1999;117:324–31.
4. Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE, et al. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg. 2014;148:2642-7.
5. Polito A, Patorno E, Costello JM, Salvin JW, Emami SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. PediatrCrit Care Med. 2011;12:e122-6.
6.Tabbutt S. Can multicenter registries determine the optimal timing of extubation after congenital heart surgery? J Thorac Cardiovasc Surg. 2016; 151:458-9.
7. Mittnacht AJ, Thanjan M, Srivastava S, Joashi U, Bodian C, Hossain S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg. 2008;136:88–93.
8. Vricella LA, Dearani JA, Gundry SR, Razzouk AJ, Brauer SD, Bailey LL. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg. 2000;69:865–71
9. Garg R, Rao S, John C, et al. Extubation in the operating room after cardiac surgery in children: a prospective observational study with multidisciplinary coordinated approach. J CardiothoracVascAnesth2014;28:479–87.
10. Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. PediatrCrit Care Med 2005;6:312–8.
11. Kurachek SC, Newth CJ, Quasney MW, et al. Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med 2003;31:2657–64.
12. Fontela PS, Piva JP, Garcia PC, Bered PL, Zilles K. Risk factors for extubation failure in mechanically ventilated pediatric patients. PediatrCrit Care Med 2005;6:166–70.
13. Green J,Walters HL III, Delius RE, Sarnaik A, Mastropietro CW. Prevalence and risk factors for upper airway obstruction after pediatric cardiac surgery. J Pediatr.2015;166:332-7.
14. Gaies M, Tabbutt S, Schwartz SM, Bird GL, Alten JA, Shekerdemian LS, et al.Clinical epidemiology of extubation failure in the pediatric cardiac ICU. Pediatr. Crit Care Med. 2015;16:837-45.
15.Gupta P, Rettiganti M, Gossett JM, Yeh JC, Jefferies HE, Rice TB, et al. Risk factors
for mechanical ventilation and reintubation after pediatric heart surgery. J Thorac Cardiovasc Surg. 2016;151:451-8.e3.
16. Mahle WT, Nicolson SC, Hollenbeck-Pringle D, GaiesMG,Witte MK, Lee EK, et al. Utilizing a collaborative learning model to promote early extubation following infant heart surgery. PediatrCrit Care Med. 2016;17:939-47
17.Laudato N, Gupta P, Walters HL, Dellus RE, Mastropietro CW. Risk factors for extubation failure following neonatal cardiac surgery. PediatrCrit Care Med. 2015;16:859-67.
18. Gupta P, McDonald R, Goyal S, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 2014;24:64–72.
19. Heinle JS, Diaz LK, Fox LS. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg1997;114:413-8.
20. Shinya Miura, Nao Hamamoto, Masaki Osaki, Satoshi Nakano, and Chisato Miyakoshi, Extubation Failure in Neonates After Cardiac Surgery: Prevalence, Etiology, and Risk Factors Ann ThoracSurg 2017;103:1293–9.
21.Kurihara Y, Shime N, Miyazaki T, Hashimoto S, Tanaka Y. Clinical and hemodynamic factors associated with the outcome of early extubation attempts after right heart bypass surgery. Interact Cardiovasc ThoracSurg2009;8:624-8.
22.Wynne, R, Botti, M . Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: Clinical significance and implications for practice. Am J Crit Care 2004; 13:384–93
23.Labidi, M, Baillot, R, Dionne, B, Lacasse, Y, Maltais, F, Boulet, LP . Pleural effusions following cardiac surgery: Prevalence, risk factors, and clinical features. Chest 2009; 136:1604–11
24. Bocsi, J, Hambsch, J, Osmancik, P, Schneider, P, Valet, G, Tárnok, A . Preoperative prediction of pediatric patients with effusions and edema following cardiopulmonary bypass surgery by serological and routine laboratory data. Crit Care 2002; 6:226–33
25. Shahzad Alam, Akunuri Shalini, Rajesh G Hegde, RufaidaMazahir, Akanksha Jain
Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study 2018 Volume : 21 Page : 402-406

26.Airan, B, Sharma, R, Choudhary, SK, Mohanty, SR, Bhan, A, Chowdhari, UK, Juneja, R, Kothari, SS, Saxena, A, Venugopal, P . Univentricular repair: Is routine fenestration justified? Ann ThoracSurg 2000; 69:1900–6
Published
2021-03-11
How to Cite
MANDZUKOVSKA, Hristina. THE RISK FACTORS FOR POSTOPERATIVE OUTCOMES IN NEONATAL CARDIAC SURGERY. Journal of Morphological Sciences, [S.l.], v. 4, n. 1, p. 34-39, mar. 2021. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol4no1-6>. Date accessed: 28 mar. 2024.
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Articles