Document Detail


Impact of preoperative treatment strategies on the early perioperative outcome in neonates with hypoplastic left heart syndrome.
MedLine Citation:
PMID:  16678599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was undertaken to determine the impact of specific intensive care procedures on preoperative hemodynamics, incidence of preoperative organ dysfunction, and in-hospital mortality among neonates with hypoplastic left heart syndrome with pulmonary overcirculation and to assess the influence of the change in preoperative management on early postoperative outcome. METHODS: In this retrospective evaluation of 72 neonates with classic hypoplastic left heart syndrome and severe pulmonary overcirculation with different preoperative management strategies from 1992 to 1995 and from 1996 to 2000, univariate and multivariate analyses of risk factors were performed with stepwise logistic regression. RESULTS: Among patients with ventilatory and inotropic support from admission until surgery, degree of metabolic acidosis (lowest recorded and prerepair pH values) was significantly higher than among patients who received systemic vasodilators without ventilation before surgery. Preoperative organ dysfunction occurred in 19 of 72 patients (26%), predominantly before 1996; the most significant was hepatic failure in 13 (68%). Lowest recorded and prerepair pH values did not predict the development of organ dysfunction, whereas inotropic medication, lack of afterload reduction, and especially ventilatory support correlated significantly with organ injury. In-hospital mortality decreased from 65% (13/20) to 13% (6/46) from the first to the second period. According to multivariate analysis, ventilatory support and organ dysfunction were significantly related to in-hospital mortality. CONCLUSION: In neonates with hypoplastic left heart syndrome, systemic afterload reduction can avoid preoperative artificial respiration, identified as a significant risk factor for the development of preoperative dysfunction of end organs and in-hospital mortality.
Authors:
Jürgen Stieh; Gunther Fischer; Jens Scheewe; Anselm Uebing; Peter Dütschke; Olaf Jung; Ralph Grabitz; Hans Joachim Trampisch; Hans Heiner Kramer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  131     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-08     Completed Date:  2006-05-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-1129.e2     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric Cardiology, University Hospital Schleswig Holstein-Campus Kiel, Kiel, Germany.
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures / mortality*
Female
Hemodynamics
Hospital Mortality
Humans
Hypoplastic Left Heart Syndrome / mortality,  physiopathology,  surgery*
Infant
Infant, Newborn
Intensive Care
Lung / blood supply
Lung Diseases / etiology,  mortality
Male
Multiple Organ Failure / etiology,  mortality
Preoperative Care*
Retrospective Studies
Treatment Outcome
Vasoconstrictor Agents / therapeutic use
Vasodilator Agents / therapeutic use
Ventilators, Mechanical
Ventricular Dysfunction, Right / etiology,  mortality
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 0/Vasodilator Agents

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