Abstract 19810: Temporal Hemodynamics and Regional Perfusion after Neonatal Heart Surgery in the Current Era
Introduction: Reductions in cardiac output (CO) and elevations in systemic vascular resistance (SVR) are frequently anticipated after neonatal cardiac surgery; such perturbations are thought transient with normalization within 24 hours.
Hypothesis: A nadir in CO and elevation in SVR is uncommon after neonatal cardiac surgery in the current era of bypass management, modified ultrafiltration and aggressive systemic afterload reduction.
Methods: We prospectively evaluated neonates undergoing cardiac surgery requiring cardiopulmonary bypass. Modified ultrafiltration and a loading dose of 100 μg/kg of milrinone were standardly employed; neonates undergoing the Norwood procedure also received a loading dose of phenoxybenzamine (0.25mg/kg). Routine postoperative monitoring was supplemented by continuous mass spectrometry oxygen consumption and somatic near-infrared spectroscopy (NIRS) measurement over the first 24 postoperative hours. Data were analyzed using repeated measures ANOVA for evidence of time or physiology dependent trends.
Results: The study cohort consisted of 21 neonates (14 biventricular, 7 univentricular). CO and SVR remain relatively static over the first postoperative day. No significant time trends were noted. SVR in univentricular patients was significantly lower (−8.7 ± 1.6 dyn*sec*cm−5; p<0.001) throughout the initial postoperative period.
Conclusions: CO and SVR have significantly different postoperative profiles in the current era of neonatal cardiac surgery. Clinical perturbations in cardiac output are unlikely to be transient and may require active intervention.
- © 2010 by American Heart Association, Inc.