HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jens Scheewe Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stieh, J. Articles by Kramer, H. H. Search for Related Content PubMed PubMed Citation Articles by Stieh, J. Articles by Kramer, H. H. Related Collections Congenital - cyanotic

J Thorac Cardiovasc Surg 2006;131:1122-1129
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Impact of preoperative treatment strategies on the early perioperative outcome in neonates with hypoplastic left heart syndrome

^a Department of Pediatric Cardiology, University Hospital Schleswig Holstein–Campus Kiel, Kiel, Germany
^b Department of Cardiovascular Surgery, University Hospital Schleswig Holstein–Campus Kiel, Kiel, Germany
^c Department of Anesthesiology, University Hospital Schleswig Holstein–Campus Kiel, Kiel, Germany
^d Department of Medical Statistics, Ruhr-University Bochum, Bochum, Germany

Received for publication March 14, 2005; revisions received November 10, 2005; accepted for publication December 22, 2005.

^_* Address for reprints: Hans-Heiner Kramer, MD, University Hospital Schleswig Holstein–Campus Kiel, Department of Pediatric Cardiology, Schwanenweg 20, D-24105 Kiel, Germany (Email: kramer{at}pedcard.uni-kiel.de).

OBJECTIVE: This study was undertaken to determine the impact of specific intensive care procedures on preoperative hemodynamics, incidence of preoperative organ dysfunction, and in-hospital mortality among neonates with hypoplastic left heart syndrome with pulmonary overcirculation and to assess the influence of the change in preoperative management on early postoperative outcome.

METHODS: In this retrospective evaluation of 72 neonates with classic hypoplastic left heart syndrome and severe pulmonary overcirculation with different preoperative management strategies from 1992 to 1995 and from 1996 to 2000, univariate and multivariate analyses of risk factors were performed with stepwise logistic regression.

RESULTS: Among patients with ventilatory and inotropic support from admission until surgery, degree of metabolic acidosis (lowest recorded and prerepair pH values) was significantly higher than among patients who received systemic vasodilators without ventilation before surgery. Preoperative organ dysfunction occurred in 19 of 72 patients (26%), predominantly before 1996; the most significant was hepatic failure in 13 (68%). Lowest recorded and prerepair pH values did not predict the development of organ dysfunction, whereas inotropic medication, lack of afterload reduction, and especially ventilatory support correlated significantly with organ injury. In-hospital mortality decreased from 65% (13/20) to 13% (6/46) from the first to the second period. According to multivariate analysis, ventilatory support and organ dysfunction were significantly related to in-hospital mortality.

CONCLUSION: In neonates with hypoplastic left heart syndrome, systemic afterload reduction can avoid preoperative artificial respiration, identified as a significant risk factor for the development of preoperative dysfunction of end organs and in-hospital mortality.

This article has been cited by other articles:

				B. A. Johnson, G. M. Hoffman, J. S. Tweddell, J. R. Cava, M. Basir, M. E. Mitchell, M. C. Scanlon, K. A. Mussatto, and N. S. Ghanayem Near-infrared spectroscopy in neonates before palliation of hypoplastic left heart syndrome. Ann. Thorac. Surg., February 1, 2009; 87(2): 571 - 579. [Abstract] [Full Text] [PDF]

				J. Li, G. Zhang, H. Holtby, B. Bissonnette, G. Wang, A. N. Redington, and G. S. Van Arsdell Carbon dioxide-a complex gas in a complex circulation: Its effects on systemic hemodynamics and oxygen transport, cerebral, and splanchnic circulation in neonates after the Norwood procedure. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1207 - 1214. [Abstract] [Full Text] [PDF]

				J. Li, G. Zhang, H. Holtby, S. Cai, M. Walsh, C. A. Caldarone, and G. S. Van Arsdell Significant correlation of comprehensive Aristotle score with total cardiac output during the early postoperative period after the Norwood procedure J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 123 - 128. [Abstract] [Full Text] [PDF]