Influence of the type of congenital heart defects on epithelial lining fluid composition in infants undergoing cardiac surgery with cardiopulmonary bypass

Simonato, Manuela; Baritussio, Aldo; Carnielli, Virgilio P.; Vedovelli, Luca; Falasco, Gianclaudio; Salvagno, Michele; Padalino, Massimo A.; Cogo, Paola

doi:10.1038/pr.2017.326

Cited by 7 publications

(4 citation statements)

References 43 publications

(50 reference statements)

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“…ventricular septal defect or tetralogy of Fallot, respectively) [ 20 ]. Also, TA's composition has distinctive patterns in different CHD [ 21 ]. In fact, preoperatively, surfactant-specific protein SP-B is increased in all CHD, while MPO (neutrophil) activity is decreased only in tetralogy of Fallot, and albumin and surfactant-specific protein-A are increased only in ASD and ventricular septal defect, compared to age-matched controls [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

Padalino

Vedovelli

Simonato

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The aim of this study was to evaluate if a ‘protective’ (low-tidal/low-frequency) ventilation strategy can shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease (CHD) undergoing repair with cardiopulmonary bypass (CPB). METHODS This is a single-centre prospective, interventional study, including children with CHD under the age of 5 years, undergoing open-heart surgery with a CPB >60 min, in hypothermia, haemodynamically stable, and without evident genetic abnormalities. Assist-control ventilation (tidal volume of 4 ml/kg, 10 breaths/min, positive end-expiratory pressure 5 cmH2O and FiO2 0.21) was applied in a cohort of patients during CPB. We compared clinical outcomes and in fully ventilated versus non-ventilated (control) patients. Propensity score was used to weigh ventilated and control groups to correct for the effect of other confounding clinical variables. Clinical and ventilation parameters and lung inflammatory biomarkers in tracheal aspirates were measured. The primary outcome was the postoperative intubation time of more or less than 48 h. RESULTS We included 140 children (53 ventilated, 87 non-ventilated) with different CHD. There were no deaths or adverse events in ventilated patients. Using a weighted generalized linear model, we found no sufficient evidence for an effect of intraoperative ventilation on postoperative intubation time [estimate 0.13 (95% confidence interval, –0.08; 0.35), P = 0.22]. CONCLUSIONS Continuous low-tidal/low-frequency mechanical ventilation during CPB is safe and harmless. However, no significant advantages were found when compared to non-ventilated patients in terms of postoperative ventilation time.

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Section: Discussionmentioning

confidence: 99%

Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

Padalino

Vedovelli

Simonato

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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“…15 A prior study by Simonato et al found a difference in the composition of epithelial uid in patients with CHD at the time of surgery, suggesting there may be differences in the biological pro le of such patients that may account for differences in pulmonary mechanics. 21 These studies, along with the ndings in our study, suggest that there may be multiple factors, including pulmonary blood ow, associated with the changes in pulmonary mechanics in neonates with critical CHD, necessitating future investigations.…”

Section: Discussionmentioning

confidence: 75%

Presurgical pulmonary function tests in the first few days of life in neonates with congenital heart disease, a pilot study

Leeds,

Muralidaran,

Johnson

et al. 2024

J Perinatol

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ObjectiveTo compare early pulmonary function tests (PFTs) in neonates with critical congenital heart disease (CHD) compared to a historical reference group. DesignInfants > 37 weeks gestation with critical CHD were studied within the rst few days of life and prior to cardiac surgery and compared to data from a published reference group. Passive respiratory resistance (Rrs) and compliance (Crs) were measured with the single breath occlusion technique following speci c acceptance criteria. The study was powered for a 30% difference in Rrs. ResultsPFTs in 24 infants with CHD were compared to 31 historical reference infants. There was no difference in the Rrs between the groups. The infants with CHD had a signi cantly decreased Crs (1.02 ± 0.26 mL/cmH2O/kg versus 1.32 ± 0.36; (p < 0.05; mean ± SD)). ConclusionsFurther prospective studies are required to quantify early PFTs in infants with CHD of different phenotypes.

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“…This includes baseline deleterious effects on the lungs by CHD such as lung injury from over or under-perfusion, alterations in the composition of surfactant, and differences in lower airway resistance. 11 Additionally for those with certain types of heart lesions, respiratory infections can precipitate pulmonary hypertensive crisis and/or heart failure. As a result of these factors, infants with CHD and respiratory infections may be more likely to have more severe illness with higher morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory infections in hospitalised infants with congenital heart disease

Ahuja

Mack

et al. 2020

Cardiol Young

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Objectives: To assess the overall burden and outcomes of acute respiratory infections in paediatric inpatients with congenital heart disease (CHD). Methods: This is a retrospective cross-sectional study of non-neonates <1 year with CHD in the Kid’s Inpatient Database from 2012. We compared demographics, clinical characteristics, cost, length of stay, and mortality rate for those with and without respiratory infections. We also compared those with respiratory infections who had critical CHD versus non-critical CHD. Multi-variable regression analyses were done to look for associations between respiratory infections and mortality, length of stay, and cost. Results: Of the 28,696 infants with CHD in our sample, 26% had respiratory infections. Respiratory infection-associated hospitalisations accounted for $440 million in costs (32%) for all CHD patients. After adjusting for confounders including severity, mortality was higher for those with respiratory infections (OR 1.5, p = 0.003), estimated mean length of stay was longer (14.7 versus 12.2 days, p < 0.001), and estimated mean costs were higher ($53,760 versus $46,526, p < 0.001). Compared to infants with respiratory infections and non-critical CHD, infants with respiratory infections and critical CHD had higher mortality (4.5 versus 2.3%, p < 0.001), longer mean length of stay (20.1 versus 15.5 days, p < 0.001), and higher mean costs ($94,284 versus $52,585, p < 0.001). Conclusion: Acute respiratory infections are a significant burden on infant inpatients with CHD and are associated with higher mortality, costs, and longer length of stay; particularly in those with critical CHD. Future interventions should focus on reducing the burden of respiratory infections in this population.

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Influence of the type of congenital heart defects on epithelial lining fluid composition in infants undergoing cardiac surgery with cardiopulmonary bypass

Cited by 7 publications

References 43 publications

Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

Protective continuous ventilation strategy during cardiopulmonary bypass in children undergoing surgery for congenital heart disease: a prospective study

Presurgical pulmonary function tests in the first few days of life in neonates with congenital heart disease, a pilot study

Acute respiratory infections in hospitalised infants with congenital heart disease

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