Low Cardiac Output Syndrome in Children After Open Heart Surgery In National Cardiovascular Center – Indonesia Predictor and Clinical Result
Abstract
Background. A Low cardiac output syndrome (LCOS) was defined as poor perfusion due to transient myocardial dysfunction.The purpose of this study was to identify patients at risk for the development of LCOS in pediatric after cardiac surgery.Methods and results.The patient characteristics that were independent predictors of LCOS were identified among472 consecutive pediatric pa-tients who underwent cardiac surgery at the National Cardiovascular Center – Indonesia between January 2005 and December2005. The overall preva-lence of LCOS was 15.43 % (n= 73). Logistic regression analyses identified eight independent predictors of LCOS and calculated the factor-ad-justed odds ratiosassociated with each predictor: (1) residual lesion (odds ratio 141.98); (2) complexity score(odds ratio 1.74);(3) Cardiopulmonary bypass (CPB) time (odds ratio1.01); (4) preoperative Intensive Care Unit (ICU) (odds ratio 8.51); (5) preoperative Congestive Heart Failure (CHF) (odds ratio 3.14); (6) bleeding (oddsratio 24.88); (7) arrhythmia (odds ratio 4.78); and (8) pulmonary hypertension (odds ratio3.75). The opera-tive mortality rate was higherin patients in whom LCOS developed than in those in whom it did not develop (39.72% versus 0.75%, p<0.001). Mean basic complexity score was 6.25 with mortality rate 6.76, and the overall performance was 5.83.
Conclusions. Compared to STS and EACTS, the performance of National Cardiovascular Center– Indonesia was still lower. LCOS caused longer time of intubation time, ICU and hospital stay. There were eight independents predictor that can be used to predicts LCOS in pediatric patients after open heart surgery. Patients at high risk for the develop-ment of low cardiacoutput syndrome should be the focus of more inten-sive management to prevent the development of LCOS.
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References
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Thorac Surg. 2002;74:830-6; discussion 836-7
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Scwartz SM,Duffy JY, Pearl JM, Nelson DP. Cellular and mo-lecular aspects of myocardial dysfunction. Crit Care Med. 2001;29:S214-9
McDonough JL, Labugger R, Pickett W, Tse MY, Mackenzie S, Pang SC, Atar D, Ropchan G, Van Eyk JE. Cardiac troponin I is modified in the myocardium of bypass patients. Circulation.
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Heart Disease. Circulation. 2003;107:996-1002
Jacobs, JR, Lacour-Gayet FG, Jacobs ML, Clarke DR, Tchervenkov CI, Gayno W, et al. Initial Application in the STS Coengenital Database of Complexity Adjustment to Evalu-ate Surgical Case Mix and Results. Ann Thorac Surg 2005;79:1635-49
Lacour-Gayet FG, Clarke D, Jacobs J, Comas J, Daebrits S, Daenen W, Gaynor W et al. The Aristotle score : a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg2004;25-911-924
Duke T, Butt W, South M, Karl TR. Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg 1997;114:1042-52
Duke T, Stocker C. Butt W. Monitoring children after cardiac surgery : a minimalist approach might be maximally effective. Critical Care and Resuscitation2004;6: 306-310
Hoffman TM, Wernovsky G, Atz AM, et al Prophylactic intra-venous use of milrinone after cardiac operation inpediatrics (PRIMACORP) study. Am Heart J. 2002;143:15-21
Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmo-nary bypass and circulatory arrest. Circulation. 1995;92:2226-2235
Rossi AF, Khan DM, Hannan R, Bolivar J. Zaidenwebere M, Burke R. Goal-directed medical therapy and point of care test-ing improve outcomes after congenital heart surgery. Intensive
Care Med. (2005) 31:98-104
Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapectic, and parhmacological considerations. Anesth Analg. 1997 :85:766-82
Dreyer WJ, Michael LH, Millman EE, Berens KL, Geske RS. Neutrophil sequestration and pulmonary dysfunction in a ca-nine model of open heart surgery with cardiopulmonary by-pass. Evidence for a CD18-dependent mechanism. Circulation. 1995:92:2276-83
Chaturvedi RR, Shore DF, Lincoln C, Mumby S, Kemp M, BrierlyJ, Petros A, Gutteridge JM, Hooper J, Redington AN. Acute right ventricular restrictive physiology after repair of te-tralogy of Fallot : association with myocardial injury and oxi-dative stress. Circulation. 1999;100:1540-7
Pearl JM, Nelson DP, Schwartx SM, Wagner CJ, Baurer SM, Setser EA, Duffy JY. Glucocorticoids reduce ischemia-reper-fusion-induced myocardial apoptosis in immature hearts. Ann
Thorac Surg. 2002;74:830-6; discussion 836-7
Buchhorn R, Hulpke-Wette M, Ruschewski W, Pregla R, Fielitz J, Hetzer R, Regitz-Zagrosek V. Beta-receptor downregulation in congenital heart disease : a risk factor for complications after surgical repair ? Ann Thorac Surg. 2002;73:610-3
Scwartz SM,Duffy JY, Pearl JM, Nelson DP. Cellular and mo-lecular aspects of myocardial dysfunction. Crit Care Med. 2001;29:S214-9
McDonough JL, Labugger R, Pickett W, Tse MY, Mackenzie S, Pang SC, Atar D, Ropchan G, Van Eyk JE. Cardiac troponin I is modified in the myocardium of bypass patients. Circulation.
2001;103:58-64
Hoffman TM, Bush DM, Wernovsky G, Cohen MI, Wieand TS, Gaynor JW, Spray TL, Rhodes LA. Postoperative junctional ectopic tachycardia in children : incidence, risk factors, and treat-ment. Ann Thorac Surg.2002;74:1607-11
Gold JP. STS Web Editor. Congenital Heart Surgery Database in www.sts.org/sections/stsnationatabase/ publications/execu-tive/article.html. The Socitey of Thora-cic Surgery 2006, last modified : 14 Feb 2006
Karkouti K, Wijeysundera DN, Yau TM, Beattie WS, Abdelnaem E, McCluskey SA, Ghannam M, Yeo E, Djaiani G, Karski J. The independent association of massive blood loss with mortality in cardiac surgery. Transfusion. 2005;44(10):1453-62
Jacobs JP, Jacobs ML, Maruszewski B, Lacour-Gayet FG, Clarke DR, Tchervenskov CI, Gaynor JW. Spray TL, et al Current Status of the European Association for CardioThoracic Surgery and the The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg2005;80:2278-2284
Kirklin JW, Blackstone EH. Presenting multivariable analyses. J Thorac Cardiovasc Surg1994;107:1544-55.
Naftel DC. Do different investigators sometimes produce dif-ferent multivariable equations from the same data? J Thorac Cardiovasc Surg 1994;107:1528-
Published
2007-01-03
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PDF (Bahasa Indonesia) downloads: 3424
How to Cite
Busro, P., Marwali, E., Budiwardhana, N., Koto, C., Roebiono, P., Rahajoe, A., Harimurti, G., Fakhri, D., & Rahmat, J. (2007). Low Cardiac Output Syndrome in Children After Open Heart Surgery In National Cardiovascular Center – Indonesia Predictor and Clinical Result. Indonesian Journal of Cardiology, 28(1), 10-18. https://doi.org/10.30701/ijc.v28i1.17
Section
Clinical Research
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