Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*

Cigarroa, Claire L.; Bosch, Sarah J. van den; Tang, Xiaoqi; Baird, Christopher W.; DiNardo, James A.; Kheir, John N.

doi:10.1097/pcc.0000000000001378

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…We used a composite endpoint of re-intervention (any cardiothoracic surgical or catheter-based intervention), arrhythmia (requiring medication or intervention), death and listing for heart transplantation. These endpoints are widely accepted clinically relevant endpoints [26][27][28][29].…”

Section: Follow-upmentioning

confidence: 99%

Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes

Ven

Alsaied

Juggan

et al. 2020

International Journal of Cardiology

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To assess the role of atrial function on exercise capacity and clinical events in Fontan patients. Design: We included 96 Fontan patients from 6 tertiary centers, aged 12.8 (IQR 10.1-15.6) years, who underwent cardiac magnetic resonance imaging and cardiopulmonary exercise testing within 12 months of each other from 2004 to 2017. Intra-atrial lateral tunnel (ILT) and extracardiac conduit (ECC) patients were matched 1:1 with regard to age, gender and dominant ventricle. The pulmonary venous atrium was manually segmented in all phases and slices. Atrial function was assessed by volume-time curves. Furthermore, atrial longitudinal and circumferential feature tracking strain was assessed. We determined the relation between atrial function and exercise capacity, assessed by peak oxygen uptake and VE/VCO 2 slope, and events (mortality, listing for transplant, re-intervention, arrhythmia) during follow-up. Results: Atrial maximal and minimal volumes did not differ between ILT and ECC patients. ECC patients had higher reservoir function (21.1 [16.4-28.0]% vs 18.2 [10.9-22.2]%, p = .03), lower conduit function and lower total circumferential strain (13.8 ± 5.1% vs 18.0 ± 8.7%, p = .01), compared to ILT patients. Only for ECC patients, a better late peak circumferential strain rate predicted better VE/VCO 2 slope. No other parameter of atrial function predicted peak oxygen uptake or VE/VCO 2 slope. During a median follow-up of 6.2 years, 42 patients reached the composite end-point. No atrial function parameters predicted events during follow-up. Conclusions: ECC patients have higher atrial reservoir function and lower conduit function. Atrial function did not predict exercise capacity or events during follow-up.

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Section: Follow-upmentioning

confidence: 99%

Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes

Ven

Alsaied

Juggan

et al. 2020

International Journal of Cardiology

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“…is a relatively common approach that gained in popularity after the 2007 publication by Severinghaus, 2 and reports based on this approach have shown a relationship with outcomes in patients undergoing congenital heart surgery. 3,4 However, we think it is important to appreciate what this measurement reflects.…”

mentioning

confidence: 99%

Uh-oh, some CO2 has gone missing

Woods

Hoffman

2018

The Journal of Thoracic and Cardiovascular Surgery

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In this issue of the Journal, Koth and colleagues 1 analyzed dead space ventilation fraction (Vd/Vt) in a cohort of 265 patients shortly after collateral unifocalization and report an association between increased Vd/Vt (>20%) and prolonged mechanical ventilation. The report is noteworthy-it describes an underappreciated aspect of physiology in a large cohort of patients with tetralogy of Fallot with pulmonary atresia treated at a center that is well-known for excellent outcomes with this group of patients. The authors' general message appeals to intuition-unifocalization may be associated with alveolar collapse, reperfusion injury, underperfused segments, capillary leak, interstitial edema, etc-all contributing to increased dead space and pulmonary morbidity.

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“…Consequently, a wide ETCO 2 to PaCO 2 gradient should be anticipated. 108 In addition, concomitant pulmonary processes, such as infection, aspiration, pleural effusions, and temporary or permanent diaphragmatic paralysis, 109 should be considered in patients with SCPC physiology, as impairment of ventilation may lead to both impaired oxygenation, as well as increases in PVR.…”

Section: Anesthetic Implications and Management Of Scpc Physiologymentioning

confidence: 99%

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

Choi

DiNardo

Brown

2020

Semin Cardiothorac Vasc Anesth

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The superior cavopulmonary connection (SCPC) or “bidirectional Glenn” is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.

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Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*

Cited by 12 publications

References 26 publications

Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes

Atrial function in Fontan patients assessed by CMR: Relation with exercise capacity and long-term outcomes

Uh-oh, some CO2 has gone missing

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

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