Factors influencing length of intensive care unit stay following a bidirectional cavopulmonary shunt

Interactive Cardiovascular and Thoracic Surgery - Tập 33 Số 1 - Trang 124-130 - 2021
Takashi Kido1,2, Masamichi Ono1,2, Lisa Anderl1,2, Melchior Burri3, Martina Strbad1,2, Gunter Balling4, Julie Cleuziou1,2, Alfred Hager4, Peter Ewert4, Jürgen Hörer1,2
1Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
2Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
3Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
4Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Cneter Munich, Technische Universität München, Munich, Germany

Tóm tắt

Abstract   OBJECTIVES The goal of this study was to identify the risk factors for prolonged length of stay (LOS) in the intensive care unit (ICU) after a bidirectional cavopulmonary shunt (BCPS) procedure and its impact on the number of deaths. METHODS In total, 556 patients who underwent BCPS between January 1998 and December 2019 were included in the study. RESULTS Eighteen patients died while in the ICU, and 35 died after discharge from the ICU. Reduced ventricular function was significantly associated with death during the ICU stay (P = 0.002). In patients who were discharged alive from the ICU, LOS in the ICU [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02–1.06; P < 0.001] and a dominant right ventricle (HR 2.41, 95% CI 1.03–6.63; P = 0.04) were independent risk factors for death. Receiver operating characteristic analysis identified a cut-off value for length of ICU stay of 19 days. Mean pulmonary artery pressure (HR 1.03, 95% CI 1.01–1.05; P = 0.04) was a significant risk factor for a prolonged ICU stay. CONCLUSIONS Prolonged LOS in the ICU with a cut-off value of 19 days after BCPS was a significant risk factor for mortality. High pulmonary artery pressure at BCPS was a significant risk factor for a prolonged ICU stay.

Từ khóa


Tài liệu tham khảo

Lee, 2012, Risk factor analysis for second-stage palliation of single ventricle anatomy, Ann Thorac Surg, 93, 614, 10.1016/j.athoracsur.2011.10.012

Friedman, 2011, Risk factors for failed staged palliation after bidirectional Glenn in infants who have undergone stage one palliation, Eur J Cardiothorac Surg, 40, 1000

Scheurer, 2007, Survival after bidirectional cavopulmonary anastomosis: analysis of preoperative risk factors, J Thorac Cardiovasc Surg, 134, 89.e1, 10.1016/j.jtcvs.2007.02.017

Alsoufi, 2012, Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation, Eur J Cardiothorac Surg, 42, 42, 10.1093/ejcts/ezr280

Ono, 2019, Predicted clinical factors associated with the intensive care unit length of stay after total cavopulmonary connection, J Thorac Cardiovasc Surg, 157, 2005, 10.1016/j.jtcvs.2018.10.144

Vitanova, 2019, Impact of characteristics at stage-2-palliation on outcome following fontan completion, Pediatr Cardiol, 40, 1476, 10.1007/s00246-019-02172-6

Schreiber, 2008, Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts, Eur J Cardiothorac Surg, 34, 550, 10.1016/j.ejcts.2008.04.043

Ono, 2018, Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: impact of valve morphology and underlying mechanisms on survival and reintervention, J Thorac Cardiovasc Surg, 155, 701, 10.1016/j.jtcvs.2017.08.122

Pridjian, 1993, Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle, Am J Cardiol, 71, 959, 10.1016/0002-9149(93)90914-X

Tran, 2018, Elevated pulmonary artery pressure, not pulmonary vascular resistance, is an independent predictor of short-term morbidity following bidirectional cavopulmonary connection, Pediatr Cardiol, 39, 1572, 10.1007/s00246-018-1932-6

Ono, 2016, Clinical outcome following total cavopulmonary connection: a 20-year single-centre experience, Eur J Cardiothorac Surg, 50, 632, 10.1093/ejcts/ezw091

Jeremiasen, 2020, Pulmonary vasodilator therapy in children with single ventricle physiology: effects on saturation and pulmonary arterial pressure, Pediatr Cardiol, 41, 1651, 10.1007/s00246-020-02424-w

Cnota, 2013, Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle, J Thorac Cardiovasc Surg, 145, 1288, 10.1016/j.jtcvs.2012.07.069

Cleuziou, 2008, Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months, Eur J Cardiothorac Surg, 34, 556, 10.1016/j.ejcts.2008.05.041

Shiraishi, 2018, Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation, Cardiol Young, 28, 1436, 10.1017/S1047951118001543

Bradley, 1996, Bidirectional superior cavopulmonary connection in young infants, Circulation, 94, II5

Thông tin
Thông tin xuất bản

Interactive Cardiovascular and Thoracic Surgery

Tập 33 Số 1

124-130

Thông tin tác giả