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J Thorac Cardiovasc Surg 2007;133:441-448
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Profiles of hemodynamics and oxygen transport derived by using continuous measured oxygen consumption after the Norwood procedure

Jia Li, MD, PhD, Gencheng Zhang, MD, PhD, Brian W. McCrindle, MD, MPH, Helen Holtby, MBBS, Tilman Humpl, MD, Sally Cai, MS, Christopher A. Caldarone, MD, Andrew N. Redington, MD, Glen S. Van Arsdell, MD*

Cardiac Program, the Hospital for Sick Children, Toronto, Ontario, Canada.

Received for publication May 5, 2006; revisions received August 11, 2006; accepted for publication September 6, 2006.

* Address for reprints: Glen S. Van Arsdell, MD, Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8 (Email: glen.vanarsdell{at}sickkids.ca).

OBJECTIVES: The lack of accurate measurement of hemodynamics and oxygen transport has limited our understanding of Norwood physiology and postoperative management. We used measured oxygen consumption to characterize hemodynamics and oxygen transport after the classic Norwood procedure.

METHODS: Fourteen neonates had continuous respiratory mass spectrometry to measure oxygen consumption (VO2). Arterial, superior vena caval, and pulmonary venous saturations were measured at 2- to 4-hour intervals for 72 hours postoperatively. Systemic (Qs) and pulmonary (Qp) blood flows, systemic vascular resistance (SVR) and pulmonary vascular resistance inclusive of the Blalock–Taussig shunt (BT-PVR), systemic oxygen delivery (DO2), and the oxygen extraction ratio (ERO2) were calculated.

RESULTS: Qs and DO2 were low during the first 12 hours (1.8 ± 0.6 L · min–1 · m–2 and 281 ± 86 mL · min–1 · m–2 at the 12th hour, respectively) and increased over the study period (P < .05 for both). VO2 decreased markedly during the first 24 hours (101 ± 26 to 86 ± 16 mL · min–1 · m–2, P < .0001). Consequently, ERO2 decreased significantly over the study, most rapidly during the first 24 hours (0.44 ± 0.11 to 0.28 ± 0.09, P < .0001). There was a close correlation of DO2 to SVR and to Qs (P < .0001 for both). There was no correlation of DO2 to BT-PVR (P = .14) or to Qp (P = .67). DO2 was closely correlated with hemoglobin value (P < .0001), weakly correlated with PaO 2 (P = .0002), and not correlated with arterial oxygen saturation (P = .32).

CONCLUSIONS: There is wide variability of hemodynamics and oxygen transport after the Norwood procedure. The decrease in VO2 during the first 24 hours is the main contributor to improving the balance of oxygen transport. DO2 is most closely correlated to SVR and hemoglobin and weakly correlated to PaO 2. It is not correlated to Qp. Postoperative management strategies to decrease VO2 and maintain a high hemoglobin level and a low SVR appear to be rational.

Abbreviations and Acronyms BT-PVR = pulmonary vascular resistance inclusive of the Blalock-Taussig shunt; CO = cardiac output; CPB = cardiopulmonary bypass; DO2 = systemic oxygen delivery; ERO2 = oxygen extraction ratio; Hb = hemoglobin; Qp = pulmonary blood flow; Qs = systemic blood flow; SVR = systemic vascular resistance; VO2 = oxygen consumption




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