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): Ivan M. Rebeyka Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Joffe, A. R. Search for Related Content PubMed PubMed Citation Articles by Joffe, A. R. Related Collections Congenital - cyanotic

J Thorac Cardiovasc Surg 2007;134:311-318
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Mortality after neonatal cardiac surgery: Prediction from mean arterial pressure after rewarming in the operating room

^a Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
^d Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
^b Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
^c Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
^f Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
^e Biostatistician, Research Methods Team, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Received for publication October 20, 2006; revisions received January 19, 2007; accepted for publication February 1, 2007.

^_* Address for reprints: Ari R. Joffe, MD, FRCP(C), Department of Pediatrics, 3A3.07 Walter C Mackenzie Center, 8440 112 Street, Edmonton, Alberta, Canada, T6G 2B7. (Email: ajoffe{at}cha.ab.ca).

Objective: To examine the predictive contribution of mean arterial pressure after rewarming to 34°C in the operating room to mortality after cardiac surgery in infants 6 weeks old.

Methods: In this prospective inception cohort study, 70 consecutive infants who had open cardiac surgery with deep hypothermic circulatory arrest when 6 weeks old in the years 1996 to 1999 had follow-up to 5 years of age. Demographic, preoperative, operative, and postoperative variables were recorded prospectively. The previously unexplored variables of lowest mean arterial pressure in the operating room after rewarming to 34°C were recorded retrospectively from anesthesia records. Predictor variables for death were examined using univariate and multivariate analyses.

Results: Deep hypothermic circulatory arrest time, re–cardiopulmonary bypass in the operating room, duration of mean arterial pressure below 40, 35, 30, and 25 mm Hg after rewarming in the operating room, time for lactate to return to 2 mmol/L postoperatively, and cardiopulmonary resuscitation were significantly associated with death at 1 and 5 years of age on univariate analysis. Multivariate stepwise forward logistic regression analysis found the duration of mean arterial pressure after rewarming below 30 mm Hg (odds ratio 1.094; 95% confidence interval 1.033–1.158) and cardiopulmonary resuscitation (odds ratio 13.800, 95% CI 3.062–62.194) were significant predictors of death by 5 years of age. Stepwise multiple regression using pre- and intraoperative variables accounted for 30.1% of the variability related to mean arterial pressure 30 mm Hg after rewarming.

Conclusion: In these infants, low mean arterial pressure after rewarming in the operating room, even for brief times, is significantly associated with death.