Abstract 17405: Phosphodiesterase-based Vasodilation Improves Oxygen Delivery and Clinical Outcomes Following Stage 1 Palliation
Introduction: The use of systemic vasodilators is known to decrease the incidence of postoperative cardiac arrest in infants with hypoplastic left heart syndrome (HLHS) following stage 1 palliation (S1P) with Blalock-Taussig shunt. Their impact on measured oxygen delivery (DO2) are uncharacterized.
Methods: In 2013, we implemented a treatment algorithm at our institution to standardize care and lower systemic vascular resistance (SVR) in the postoperative period (A). We measured standard hemodynamic variables in consecutive neonates prior to (n=32) and following (n=24) its implementation. 92% of these infants received a Sano modification. We continuously measured oxygen consumption (E-COVX module™, GE Healthcare) and venous oxyhemoglobin saturation (SvO2, PediaSat, Edwards) for Fick-based calculation of DO2 and SVR in a subset (n=21) of patients. Variables were compared pre and post-implementation using linear mixed effects models.
Results: Demographic, anatomic and echocardiographic risk factors were similar between groups, although aortic cross-clamp (ACC) time was significantly shorter following protocol implementation (120.9 vs 91.9 mins, P<0.001). When corrected for ACC time, serum lactate (p<0.001, B) and incidence of postoperative cardiac arrest (P=0.04, C) were lower (B), and SvO2 (P<0.001) was higher following protocol implementation. Systemic cardiac output (β[SE], 0.52 [0.32] L/min/m2; P=0.10) and systemic DO2 (β[SE], 86.7 [55.4] mL/min/m2; P=0.12, D) were higher post-implementation. DO2 was most closely correlated with SVR (r2=0.87), and commonly utilized surrogate variables such as arterial saturation (r2=0.01), SvO2 (r2=0.1), and arterial-venous saturation difference (r2=0.35) correlated poorly.
Conclusions: The implementation of a phosphodiesterase-based treatment algorithm decreased SVR, lactate accumulation and the incidence of cardiac arrest in infants with HLHS following S1P with Sano modification.
Author Disclosures: K.I. Mills: None. B.K. Walsh: None. A.K. Kaza: None. H. Bond: None. D. Wypij: None. J.A. DiNardo: None. R.R. Thiagarajan: None. J.N. Kheir: None.
- © 2015 by American Heart Association, Inc.