Oral Triiodothyronine Supplementation Decreases Low Cardiac Output Syndrome After Pediatric Cardiac Surgery

Abstract

The oral triiodothyronine for infants and children undergoing cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3) supplementation improved hemodynamic and clinical outcome parameters. We tested the validity of low cardiac output syndrome (LCOS), derived using clinical parameters and laboratory data, by comparing the LCOS diagnosis with objective parameters commonly measured in a cardiac intensive care unit (CCU) setting. OTICC, a randomized, placebocontrolled trial included children younger than 3 years with an Aristotle score between 6 and 9. We used the existing trial data set to compare the LCOS diagnosis with echocardiographic hemodynamic parameters. Additionally, we determined if LCOS, prospectively assigned during a clinical trial, served as an early predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after cross-clamp release later showed significantly lower pulse pressure, stroke volume and cardiac output, and higher systemic vascular resistance. These LCOS patients also had significantly longer time to extubation (TTE) and higher mortality rate. LCOS incidence was significantly lower in the T3 treatment group [n = 86 vs. 66, respectively, p < 0.001; OR (95% CI) 0.43 (0.36-0.52)] particularly at 6 h. Also, LCOS patients in the placebo group had significantly lower FT3 serum levels over time. These analyses confirm that early clinically defined LCOS successfully predicts cardiac dysfunction determined later by objective hemodynamic echocardiographic parameters. Furthermore, early LCOS significantly impacts TTE and mortality. Finally, the data support prior clinical trial data, showing that oral T3 supplementation decreases early LCOS in concordance with reducing TTE.

Prognostic Significance of Thyroid Hormone For Prolonged Mechanical Ventilation In Critically Ill Patients With Cardiac Surgery

“…To be speci c, 11 patients died of septic shock and multiple organ failure, 8 patients died of malignant arrhythmia and cardiac arrest, 2 patients died of heart failure and multiple organ failure, and 1 patient died of gastrointestinal hemorrhage. Compared with the control, the prolonged MV group had a markedly longer length of hospital stay (27 days [21, 37] vs. 22 days [17, 28], P=0.002) and ICU stay (12 days [8, 19] vs. 5 days [4,10], P<0.001), as well as a prolonged duration of MV (8 days [5,10] vs. 3 days [3,4], P<0.001). No statistically signi cant difference was identi ed in the common clinical parameters (e.g., gender, age, BMI, APACHE II score and euroSCORE) between the control and the prolonged MV group.…”

Inflammatory and neurohormonal modulation for congenital heart surgery: The quest continues

“…4,5 Recent studies have also demonstrated the hemodynamic benefits of oral T 3 after CPB. 6,7 To our knowledge, this is the first study to use oral T 4 successfully in this setting. The results of this study are fascinating for several reasons.…”

A prospective randomized clinical study of perioperative oral thyroid hormone treatment for children undergoing surgery for congenital heart diseases

“…[ 4 19 20 21 22 23 ] T3 supplementation has been tried during and after cardiac surgery with the presumption that it will enhance cardiac function along with hemodynamics by its vasoactive inotropic effects. [ 5 6 7 9 12 24 ] The therapeutic dose of hypothyroidism in infants ranges from 10 to 15 μg/kg/day, with younger patients requiring higher dosages. We decided to uniformly administer a dose of 10 μg/kg/day in a single dose which is higher than doses administered in earlier studies.…”

“…It has been reported in pediatric patients that T3 supplements have beneficial inotropic effects and can prevent Low cardiac output state (LCOS) in the immediate postoperative course. [ 5 6 ] The T3 supplements have been administered either intravenously (IV) or enterally by different workers. [ 7 8 9 ] The benefit of supplemental T3 or T4 in reducing hospital stay postoperatively makes it an attractive proposition as an adjunct to fast tracking which is practiced by some centers.…”