Marco Modestini, Dario Massari, Susanne Huisman, Michel M.R.F. Struys, Marcus T.R. Roofthooft, Jaap Jan Vos
Beatrix Children’s Hospital, University Medical Center Groningen and University of Groningen.
Netherlands
Journal of Cardiothoracic and Vascular Anesthesia
J Cardiothorac Vasc Anesth 2024;
DOI: 10.1053/j.jvca.2024.09.141
Abstract
Objectives: This study aimed to assess the impact of persistent pulmonary hypertension of the newborn (PPHN) on perioperative morbidity and mortality in patients with dextro-transposition of the great arteries. Secondarily, we evaluated the association between postoperative outcomes and intraoperative variables including the duration of cardiopulmonary bypass, cerebral oxygen desaturation, and hypotension.
Design: Retrospective observational study.
Setting: Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands, over a 14-year period from January 2005 to December 2018.
Participants: The study included 99 consecutive patients with simple dextro-transposition of the great arteries with or without a ventricular septal defect.
Interventions: All patients received preoperative management including intravenous prostaglandin E1 and, when necessary, a balloon atrial septostomy. Patients were then scheduled for an arterial switch operation.
Measurements and main results: Patients were divided into a PPHN and a non-PPHN group. The outcomes assessed included mortality (overall, preoperative, 30-day postoperative and late mortality) and postoperative morbidity (length of ventilatory support, intensive care unit and hospital stay, delayed sternal closure and resternotomy). PPHN was present in 31% of patients. Overall mortality was 8.1%, with no difference between PPHN and non-PPHN patients (9.7 v 7.4%, p = 0.70). PPHN had no effect on morbidity outcomes. A lower weight at birth was associated with preoperative mortality. Duration of cardiopulmonary bypass and intraoperative hypotension were associated with longer intensive care unit stay. Intraoperative hypotension and cerebral oxygen desaturation had no significant impact on mortality.
Conclusions: PPHN did not significantly affect perioperative morbidity and mortality in d-TGA patients, suggesting a more favorable prognosis than previously reported.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes