Non‐invasive measurement of cardiac output using <scp>AESCULON</scp><sup>®</sup> mini after Fontan operation

Yoshitake, Shuichi; Miyamoto, Takashi; Tanaka, Yuki; Naito, Yuji

doi:10.1111/ped.13084

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…Statistically, children with less SVV variation are more likely to be in a nonresponse state. Yoshitake et al [ 26 ] used noninvasive hemodynamic monitoring to evaluate the cardiac output after Fontan operation by measuring the parameters of cardiac function in the patients with single left ventricular (SLV) and single right ventricular (SRV). Their results showed that the mean SVV (SLV : SRV) was 13.9% : 15.5%, which is similar to our study.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Song

Hou

Bai

et al. 2020

BioMed Research International

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Background. Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to maintain an appropriate pressure gradient between the systemic vein and the left atrium to ensure the effective volume of systemic circulation. However, there is a lack of effective indexes to evaluate fluid responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is aimed at validating the sensitivity and specificity of SVV and central venous pressure (CVP) in assessing the fluid responsiveness of Fontan patients. Method. Sixty-four children with single ventricle who underwent modified Fontan operation between May 2018 and January 2020 were included in this study. Patients were administered 10 ml·kg-1 albumin for fluid challenge within 10 min after cardiopulmonary bypass. Before and after fluid challenge, the invasive arterial pressure module was connected to MostCare™ equipment to collect the cardiac index (CI) and SVV dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with Δ CI ≥ 15 % were classified into the responder (R) group and those with Δ CI < 15 % into the nonresponder (NR) group. Using SVV and CVP as indicators, the receiver operating characteristic (ROC) curve of the patients was established, and the area under curve (AUC), diagnostic threshold, sensitivity, and specificity were calculated. Results. The SVV values were 16.28% (25th and 75th percentiles 14.17%-19.24%) and 13.68% (25th and 75th percentiles 12.90%-15.89%) before and after fluid challenge treatment in responders, respectively, and the values were 18.60 ± 1.83 mmHg before and 20.20 ± 2.39 mmHg for CVP after treatment. The AUC of SVV was 0.74 (95% confidence interval (CI) 0.54-0.94, P < 0.05 ), and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7%. Meanwhile, the AUC of CVP was 0.70 (95% CI 0.50-0.92, P > 0.05 ), and the cutoff value was 19.5 mmHg, offering a sensitivity of 58% and a specificity of 76%. Conclusion. SVV exhibited a good predictive value for fluid responsiveness in pediatric Fontan patients. Appropriate fluid therapy according to SVV could improve the cardiac function of such patients. Trial registration. This study was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654. Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035).

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Section: Discussionmentioning

confidence: 99%

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Song

Hou

Bai

et al. 2020

BioMed Research International

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“…Statistically, children with less SVV variation are more likely to be in a non-response state. Yoshitake et al (24) used noninvasive hemodynamic monitoring to evaluate the cardiac output after Fontan operation by measuring the parameters of cardiac function in the patients with single left ventricular (SLV) and single right ventricular (SRV). Their results showed that the mean SVV (SLV : SRV) was 13.9% : 15.5%, which is similar to our study.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

Song

Hou

Bai

et al. 2020

Preprint

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Background: Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to ensure the effective volume of systemic circulation by maintaining an appropriate pressure gradient between the systemic vein and the left atrium. However, there is a lack of effective indexes to evaluate volume responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is to validate the sensitivity and specificity of SVV vs. central venous pressure (CVP) in assessing volume responsiveness of Fontan patients.Method: 64 children were included in this prospective study with single-ventricle who underwent modified Fontan operation between May 2018 and January 2020. Patients were given 10ml·kg− 1 albumin for volume challenge within 10 min after CPB. Before and after volume challenge, the invasive arterial pressure module was connected to Mostcare™ equipment to collect SBP, MBP, DBP, SVV, CI and SVRI dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with ΔCI ≥ 15% were classified into response (R) group and patients with ΔCI < 15% into non-response (NR) group. Using SVV and CVP as indicators, the ROC of the patients was established, and the AUC, diagnostic threshold, sensitivity and specificity were calculated.Results: The 64 pediatric patients included with a mean age of 4.85 ± 1.20 years, a mean height of 98.00 ± 16.74 cm and a mean weight of 15.65 ± 5.37 kg. The SVV value was 17.15 ± 3.97% and 13.45 ± 2.45% before and after fluid challenge treatment vs. 18.60 ± 1.83 mmHg and 20.20 ± 2.39 mmHg for CVP in responders. The AUC of SVV was 0.74 (95% confidence interval [CI] 0.54–0.94, P < 0.05) and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7% vs.0.70 (95% CI 0.50–0.92, P > 0.05), 19.5 mmHg, 58% and 76% for CVP.Conclusion: SVV exhibited a good predictive value for volume responsiveness in pediatric Fontan patients. Appropriate volume therapy according to SVV could improve the cardiac function of such patients.Trial registration: This research was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654.Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035)

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“…stated that R P remains low for many decades, but is expected to increase at older age [ 14 ]. In contrast, many failing Fontan cases pertain to the pediatric population, hence the surgery is usually performed at the age of 1–5 years [ 15 ]. Therefore, a distinction has been made between the early Fontan patient (Table 1 ) and the late Fontan patient (Table 2 ).…”

Section: Methodsmentioning

confidence: 99%

In-vitro performance of a single-chambered total artificial heart in a Fontan circulation

et al. 2021

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An in-vitro study was conducted to investigate the general feasibility of using only one pumping chamber of the SynCardia total artificial heart (TAH) as a replacement of the single ventricle palliated by Fontan circulation. A mock circulation loop was used to mimic a Fontan circulation. The combination of both ventricle sizes (50 and 70 cc) and driver (Freedom Driver and Companion C2 Driver) was investigated. Two clinical relevant scenarios (early Fontan; late Fontan) as derived from literature data were set up in the mock loop. The impact of increased transpulmonary pressure gradient, low atrial pressure, and raised central venous pressure on cardiac output was studied. From a hemodynamic point, the single-chambered TAH performed sufficiently in the setting of the Fontan circulation. Increased transpulmonary pressure gradient, from ideal to pulmonary hypertension, decreased the blood flow in combinations by almost 2 L/min. In the early Fontan scenario, a cardiac output of 3–3.5 L/min was achieved using the 50 cc ventricle, driven by the Companion C2 Driver. Even under pulmonary hypertension, cardiac outputs greater than 4 L/min could be obtained with the 70 cc pump chamber in the late Fontan scenario. In the clinically relevant Fontan scenarios, implementation of the single chambered TAH performed successfully from a hemodynamic point of view. The replacement of the failing univentricular heart by a single chamber of the SynCardia TAH may provide an alternative to a complex biventricular repair procedure or ventricular support in Fontan patients.

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Non‐invasive measurement of cardiac output using AESCULON^® mini after Fontan operation

Abstract: CI does not differ with laterality of the single ventricle. SRV VET, however, was significantly shorter than SLV VET in the acute postoperative period. Conversely, SRV HR was higher than SLV HR, which may mean that SRV compensates for lower VET by increasing HR.

Cited by 6 publications

References 13 publications

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

In-vitro performance of a single-chambered total artificial heart in a Fontan circulation

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Non‐invasive measurement of cardiac output using AESCULON® mini after Fontan operation

Abstract: CI does not differ with laterality of the single ventricle. SRV VET, however, was significantly shorter than SLV VET in the acute postoperative period. Conversely, SRV HR was higher than SLV HR, which may mean that SRV compensates for lower VET by increasing HR.

Cited by 6 publications

References 13 publications

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation

Prediction of Volume Responsiveness by Stroke Volume Variation vs. Central Venous Pressure in Children Undergoing Fontan Operation

In-vitro performance of a single-chambered total artificial heart in a Fontan circulation

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Product

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Non‐invasive measurement of cardiac output using AESCULON^® mini after Fontan operation