Risk Factors for Longer Hospital Stay Following the Fontan Operation

Sasaki, Jun; Dykes, J.C.; Sosa, Lisa J.; Salvaggio, Jane; Tablante, Milagros D.; Ojito, Jorge; Khan, Danyal; Hannan, Robert L.; Rossi, Anthony F.; Burke, Redmond P.; Wernovsky, Gil

doi:10.1097/pcc.0000000000000701

Cited by 22 publications

(25 citation statements)

References 24 publications

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“…This was expected as elevated pulmonary artery pressures after TCPC lead to elevated central venous pressure, increased chest tube drainage, and clinical right heart failure. 6, 20, 21 In contrast to a previous multi-center study, 8 we found no relationship between atrioventricular valve regurgitation and length of stay in our analysis. The mechanism of atrioventricular valve regurgitation is multifactorial in single ventricle patients, including, but not limited to, annular dilation from volume overload and leaflet tethering from papillary muscle displacement.…”

Section: Discussioncontrasting

confidence: 99%

Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection

Park

Atz

Taylor

et al. 2017

Journal of the American Society of Echocardiography

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Introduction Single-ventricle patients with elevated pulmonary vascular resistance (PVR) or end-diastolic pressure (EDP) are excluded from undergoing total cavopulmonary connection (TCPC). However, a subset of patients deemed acceptable risk experience prolonged length of stay (LOS) after TCPC. Routine assessment of ventricular function has been inadequate in identifying these high risk patients. Speckle-tracking echocardiography (STE) is a novel method for assessment of myocardial deformation that may be useful in single-ventricle patients. The aim of this study was to perform a contemporary pre-operative risk assessment for prolonged LOS to determine if STE improves risk stratification prior to TCPC. Methods Our single institution's perioperative data was retrospectively collected. The primary outcome was post-operative LOS > 14 days. Longitudinal and circumferential STE deformation measures were analyzed on echocardiograms obtained during pre-operative catheterization. Patient-specific, echocardiographic, and catheterization data were included in multi-variable logistic regression. Receiver operating characteristic area under the curves (AUC) were analyzed. Results From 2007-2014, 135 who underwent TCPC could be included in the analysis. Median LOS was 11 (IQR 9-14) days. PVR (p<0.01) and circumferential strain rate (CSR) (p<0.01) were the only variables independently associated with LOS > 14 days. For every 0.1 s−1 CSR increased, there was a 20% increased odds of prolonged LOS. The AUC for CSR was 0.70. The AUC for PVR and EDP combined was 0.68. The AUC for PVR, EDP, and CSR combined was 0.73. Conclusion Pre-operative CSR is independently associated with LOS > 14 days and improves pre-operative risk stratification in patients undergoing TCPC.

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Section: Discussioncontrasting

confidence: 99%

Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection

Park

Atz

Taylor

et al. 2017

Journal of the American Society of Echocardiography

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“…Prolonged pleural and peritoneal effusions, however, remain as a significant source of morbidity after the TCPC operation. 1,2 The high pre-operative pulmonary artery pressure is a risk factor for prolonged pleural effusion. 3 Sildenafil has been used in the treatment of pulmonary hypertension.…”

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confidence: 99%

The effect of sildenafil on pleural and peritoneal effusions after the TCPC operation

Koski

Suominen

Raissadati

et al. 2019

Acta Anaesthesiol Scand

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The total cavopulmonary connection (TCPC) operation is the last stage in the palliative treatment of patients with a univentricular heart malformation. Prolonged pleural and peritoneal effusions, however, remain as a significant source of morbidity after the TCPC operation. 1,2 The high pre-operative pulmonary artery pressure is a risk factor for prolonged pleural effusion. 3 Sildenafil has been used in the treatment of pulmonary hypertension. Sildenafil reduces pulmonary vascular resistance and the transpulmonary gradient, which could, in theory, decreases pleural and peritoneal effusions after the TCPC operation. 4 Therefore, in 2006, our institution started the administration of sildenafil after the TCPC operation for occasional patients and usually later than 24 hours after the operation, and since 2009, the majority of the patients received their first dose of sildenafil pre-operatively in the morning of the operation.However, the benefits of sildenafil have been controversial in the two recent retrospective Fontan series. 5,6 Our aim in this study was to analyze the effect of prophylactic sildenafil on pleural and peritoneal effusions during the first post-operative day (POD) after the TCPC surgery. We hypothesized that the

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“…Prolonged length of stay was defined as length of stay greater than the 75th percentile at our institution. 21…”

Section: Definitionsmentioning

confidence: 99%

Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

et al. 2020

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Introduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.

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Risk Factors for Longer Hospital Stay Following the Fontan Operation

Cited by 22 publications

References 24 publications

Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection

Speckle-Tracking Echocardiography Improves Pre-operative Risk Stratification Before the Total Cavopulmonary Connection

The effect of sildenafil on pleural and peritoneal effusions after the TCPC operation

Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

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