Heightened Dependence of Left-Heart Filling Pressures on Right-Heart Failure in Congenital Heart Disease

Egbe, Alexander C.; Vojjini, Rahul; Badawy, Mohamed; Jain, Vaibhav; Bonnichsen, Crystal R.; Reddy, Yogesh N.V.; Obokata, Masaru; Borlaug, Barry A.

doi:10.1016/j.cjca.2020.02.084

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…Congenital heart disease (CHD) is kind of heart disease caused by abnormal development of the heart and blood vessels in the fetus, and it is very common in the clinical pediatric cardiology [ 1 ]. Because of its inability to heal itself, relevant surgery treatment is needed for patients with CHD [ 2 ]. The early diagnosis and treatment of CHD is essential to the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Song

Dang

Dong

2021

J Cardiothorac Surg

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Background It’s necessary to analyze the related risk factors and complications of low cardiac output syndrome (LCOS) after operation in children with congenital heart disease (CHD), to elucidate the management strategy of LCOS. Methods CHD children admitted to the department of cardiology in our hospital from January 15, 2019 to October 31, 2020 were included. The personal and clinical data of CHD children with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. Besides, the complication and mortality of LCOS and no LCOS patients were compared. Results A total of 283 CHD patients were included, the incidence of postoperative LCOS in CHD patients was 12.37%. There were significant differences in the age, preoperative oxygen saturation, two-way ventricular shunt, duration of CPB and postoperative residual shunt between two groups (all p < 0.05). Logistic regression analyses indicated that age ≤ 4y(OR2.426, 95%CI1.044 ~ 4.149), preoperative oxygen saturation ≤ 93%(OR2.175, 95%CI1.182 ~ 5.033), two-way ventricular shunt (OR3.994, 95%CI1.247 ~ 6.797), duration of CPB ≥ 60 min(OR2.172, 95%CI1.002 ~ 4.309), postoperative residual shunt (OR1.487, 95%CI1.093 ~ 2.383) were the independent risk factors of LCOS in patients with CHD (all p < 0.05). There were significant differences in the acute liver injury, acute kidney injury, pulmonary infection, tracheotomy, duration of mechanical ventilation, length of ICU stay and mortality (all p < 0.05), no significant difference in the 24 h drainage was found(p = 0.095). Conclusion LCOS after CHD is common, more attentions should be paid to those patients with age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt to improve the prognosis of CHD patients.

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Section: Introductionmentioning

confidence: 99%

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Song

Dang

Dong

2021

J Cardiothorac Surg

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“…1,2 There are, sometimes, significant variations in the treatment pathways and options for a given CHD lesion, and the choice of therapy would influence the clinical presentation, natural history, and outcomes for the given lesion. [3][4][5][6][7] These differences in the underlying structural lesions, and the physiologic adaptations to therapies, create significant heterogeneity, which makes risk stratification very challenging in this population.…”

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confidence: 99%

Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease

Egbe

Miranda

Jain

et al. 2023

Circ: Heart Failure

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BACKGROUND: The prognostic role of the congenital heart disease (CHD) anatomic/physiologic classification has not been systematically studied. The purpose of this study was to determine whether CHD physiologic stage provided improvement in prognostic power (to predict all-cause mortality) beyond conventional clinical risk models. METHODS: Retrospective study of adults with CHD at the Mayo Clinic (2003–2019). The CHD physiologic stage was assessed at baseline and 36 (24–48) months, and patients were classified into stages A to D at these time points. Clinical stability (remaining in the same stage), clinical improvement (moving to less advanced stage), and clinical deterioration (moving to more advanced stage) were determined at 36 months. We defined conventional clinical risk indices as age/sex, functional class, comorbidities, cardiac procedures, hepatorenal dysfunction, and ventricular/valvular dysfunction. RESULTS: Of 5321 patients, 1649 (31%), 1968 (37%), 1224 (23%), and 480 (9%) were in stages A, B, C, and D at baseline. Of 5321 patients, 4588 (86%) also had assessments at 36 months, and of these patients, 3347 (73%), 386 (8%), and 855 (19%) had clinical stability, deterioration, and improvement, respectively. Patients with clinical improvement were more likely to have undergone cardiac procedures between both assessments. Both baseline CHD physiologic stage (hazard ratio, 1.13 [95% CI, 1.09–1.17]; P <0.001, per unit increase in stage) and change in CHD physiologic stage (hazard ratio, 1.46 [95% CI, 1.32–1.61]; P =0.007, per unit increase in stage) were associated with mortality after adjustments for conventional risk indices and provided incremental improvement in prognostic power beyond conventional clinical risk models as evidence by an increase in C statistic from 0.702 (0.681–0.724) to 0.769 (0.754–0.787). CONCLUSIONS: The CHD physiologic stage can potentially be used for risk stratification, as well as to monitor disease progression and response to therapy.

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Heightened Dependence of Left-Heart Filling Pressures on Right-Heart Failure in Congenital Heart Disease

Cited by 2 publications

References 25 publications

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Prognostic Value of the Anatomic-Physiologic Classification in Adults With Congenital Heart Disease

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