Abstract 2204: High Volume Resuscitation in the Post-Operative Fontan Predicts Non-Favorable CICU Outcome
Introduction: Mortality following the Fontan operation is low in the current era. However, factors contributing to early post-operative morbidity are not clearly understood.
Methods: All patients admitted following a Fontan operation between June 2001 and December 2005 were analyzed in a retrospective fashion. The non-favorable composite outcome group included patients with any one of the following CICU events: >75%ile for mechanical ventilation or pleural drainage time, ECMO, Fontan takedown, or death. A multivariable model was created to compare demographic, anatomic, and physiologic variables among the outcome groups.
Results: There were 226 patients in the cohort. Median age and weight were 2.6 yrs (0.4 – 41.5 yrs) and 2.5kg (8.4 – 82 kg) respectively. The most common diagnosis was hypoplastic left heart syndrome (36.9%), and a systemic right AV valve was present in 141 (62.7%). The lateral tunnel fenestrated Fontan was the most common surgery (n= 195, 87.2%), with AV valve plasty (n=20, 8.8%) and PA augmentation (n=19, 8.4%) as secondary interventions. High volume resuscitation, defined as the need for >87.8 ml/kg (>75%ile) of volume expansion on the first post-operative night, was required in 56 patients. The majority (80.1%) of resuscitative fluid was given in the form of 5% albumin. The mean (IQR) time of mechanical ventilation and pleural drainage was 19.8hrs (13.6–28.4 hrs), and 6 days (4–9 days). Extracoporeal membrane oxygenation (ECMO, n=7, 3.1%), takedown (n=2, 0.9%) and death (n=2, 0.9%) were rare. Eighty-nine patients met criteria for the non-favorable outcome group. Univariate risk factors for non-favorable outcome were pre-operative PVR (p=0.016), deep hypothermic circulatory arrest (p=0.046), CPB time (p=0.002), elevated lactate (p<0.018), CICU central venous pressure (p<0.001), common atrial pressure (p=0.019), inotropic score (p<0.001), and high volume resuscitation, (p<0.001). A multivariable model demonstrated high volume resuscitation (OR 3.68, 95% CI 1.74, 7.78) as the only independent risk factor for non-favorable CICU outcome.
Conclusions: High volume resuscitation is an independent risk factor for non-favorable outcome, and may be a surrogate for additional mediators that contribute to short-term results.