Extubation on the operating table in patients with right ventricular pressure overload undergoing biventricular repair†

Abstract

OBJECTIVES Right ventricular pressure overload, which can result in restrictive right ventricular physiology, predicts slow recovery after biventricular repair of congenital heart defects. The goal of the study was to assess how extubation in the operating room influences the postoperative course in these patients. METHODS Between January 2013 and June 2017, a total of 65 children [median age 0.96 (0.13–9.47) years; median weight 8 (3.05–25.8) kg] with right ventricular pressure overload underwent an intracardiac correction. The most common malformations were tetralogy of Fallot (n = 34) and double outlet right ventricle with pulmonary stenosis (n = 11). The patients were divided into 2 groups: the first (n = 36) comprised late extubated (LE) and the second (n = 29), early extubated (EE) children, immediately after chest closure in the operating room. Preoperative, perioperative and postoperative records were analysed retrospectively. RESULTS Children who had EE had a lower heart rate (EE 124.2 vs LE 133.6 bpm; P = 0.03), higher arterial blood pressure (systolic: EE 87.9 ± 9.35 vs LE 81.4 ± 12.0 mmHg; P = 0.029; diastolic: EE 51.1 ± 6.5 vs LE 45.9 ± 6.64 mmHg; P = 0.003), lower central venous pressure (EE 8.6 ± 1.89 mmHg vs LE 9.9 ± 2.42 mmHg; P = 0.03), fewer pleural effusions in the first 6 postoperative days (EE 1.38 ml/kg/day vs LE 5.98 ml/kg/day; P = 0.009), shorter time of dopamine support ≥3 μg/kg (EE 7.29 ± 12.26 h vs LE 34.78 ± 38.05 h, P < 0.001), shorter stays in the intensive care unit (EE 2.7 ± 2.67 vs LE 5.0 ± 4.77 days, P = 0.001) and hospital (EE 11.8 ± 4.79 vs LE 15.5 ± 7.8 days; P = 0.022). CONCLUSIONS Extubation in the operating room of children with right ventricular pressure overload undergoing biventricular correction is feasible and safe and has a beneficial effect on the postoperative course.

Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery

“…Despite evidence supporting EE in pediatric populations undergoing cardiac surgery, especially when a total cavopulmonary connection is performed, the evidence has been much weaker for patients with ACHD. 4 , 5 , 7 , 8 , 9 , 15 A single, small retrospective study of 67 patients reported that EE was feasible and safe in patients with ACHD undergoing noncomplex surgery. 16 Ours is the first study, to our knowledge, examining a large population of adult patients undergoing congenital cardiac surgery including complex surgical procedures.…”

Combining Minimally Invasive Surgery With Ultra-Fast-Track Anesthesia in HeartMate 3 Patients: A Pilot Study

“…10,23,40 During spontaneous breathing, inspiration reduces intrathoracic pressure, which leads to increases in venous return and cardiac output. 25,40 Similarly, Nawrocki et al 46 and Kurihara et al 33 detected improved hemodynamic performance with lower CVPs and higher CIs when early instead of delayed extubation was performed following congenital cardiac surgery. In our cohort, we noted an instantaneous decrease in RVSWI post-LVAD in both groups, followed by significant improvement.…”