Postoperative heart failure after stage 1 palliative surgery for single ventricle cardiac disease
| Autor: | Michael G Foulks, Jondavid Menteer, Cynthia Herrington, Kristopher Kallin, Jeffrey I. Gold, Rika M. L. Meyer |
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| Rok vydání: | 2018 |
| Předmět: |
Inotrope
Heart Defects Congenital Male medicine.medical_specialty Cardiac output Heart disease Population 030204 cardiovascular system & hematology Hypoplastic left heart syndrome 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors Internal medicine medicine Ventricular Dysfunction Humans Postoperative Period Cardiac Surgical Procedures education Retrospective Studies Heart Failure education.field_of_study business.industry Palliative Care Infant Vascular surgery medicine.disease Cardiac surgery 030228 respiratory system Heart failure Pediatrics Perinatology and Child Health Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Pediatric cardiology. 40(5) |
| ISSN: | 1432-1971 |
| Popis: | Outcomes for patients with single ventricle congenital heart disease (SV-CHD) continue to improve over time. However, the prognosis for patients who develop heart failure immediately after surgery is poorly understood. We conducted a single-center, retrospective cohort study of patients with SV-CHD, who suffered postoperative heart failure. Of 1038 cardiac surgeries performed on 621 SV-CHD patients between 2004 and 2010, 125 patients met inclusion criteria, including non-septatable anatomy, stage 1 surgery, and verified low cardiac output or heart failure state per STS definition. Overall survival was 73.2% at 2 months, 64.9% at 1 year, 60.5% at 2 years, and 54.6% at 4 years. Inotrope dependence beyond 7 days post-op yielded 45% 2-year survival versus 68% for those who weaned from inotropes within 7 days (p = 0.02). Atrioventricular valve regurgitation (AVVR) influenced survival, and patients who developed renal failure or required ECMO fared poorly, even when they survived their hospitalization. Patients with postoperative heart failure and low cardiac output syndrome constitute a high-risk population beyond the term of the initial hospitalization and have an overall mid-term survival of 55% at 4 years. Wean from inotropic therapy is not completely reassuring in this population, as they have ongoing elevated risk of cardiac failure and death in the medium term. Ventricular dysfunction, AVVR, renal failure, and need for ECMO are all important prognostic factors for mid-term mortality. Inotrope dependence for > 7 days has important implications reaching beyond the hospitalization. |
| Databáze: | OpenAIRE |
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