JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Sally Cai
Christopher A. Caldarone
Glen S. Van Arsdell
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Li, J.
Right arrow Articles by Van Arsdell, G. S.
PubMed
Right arrow Articles by Li, J.
Right arrow Articles by Van Arsdell, G. S.
Related Collections
Right arrow Cardiac - other

J Thorac Cardiovasc Surg 2008;136:123-128
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Significant correlation of comprehensive Aristotle score with total cardiac output during the early postoperative period after the Norwood procedure

Jia Li, MD, PhD*, Gencheng Zhang, MD, PhD, Helen Holtby, MD, Sally Cai, MS, Mark Walsh, MD, Christopher A. Caldarone, MD, Glen S. Van Arsdell, MD

The Labbatt Family Heart Center, the Hospital for Sick Children, Toronto, Ontario, Canada

Received for publication June 1, 2007; revisions received December 6, 2007; accepted for publication December 18, 2007.

* Address for reprints: Jia Li, MD, PhD, Division of Cardiology, The Heart Center, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8. (Email: jia.li{at}sickkids.ca).

Background: The comprehensive Aristotle score has been proposed as an individualized measure of the complexity of a given surgical procedure and has been reported to significantly correlate with postoperative morbidity and mortality after the Norwood procedure. An important factor leading to postoperative morbidity and mortality is low cardiac output. We studied the correlation between the comprehensive Aristotle score and cardiac output (CO) in infants after the Norwood procedure.

Methods and Results: Respiratory mass spectrometry was used to continuously measure systemic oxygen consumption (VO2) in 22 infants for 72 hours postoperatively. Arterial, superior vena caval and pulmonary venous blood gases were measured at 2 to 4 hour intervals to calculate CO. The comprehensive Aristotle score was collected.

Hospital mortality was 4.5%. The comprehensive Aristotle score ranged from 14.5 to 23.5 and negatively correlated with CO (P = 0.027). Among the patient-adjusted factors, myocardial dysfunction (n = 10), mechanical ventilation to treat cardiorespiratory failure (n = 9) and atrioventricular valve regurgitation (n = 4) (P = 0.01) negatively correlated with CO (P = 0.06 to 0.07). Aortic atresia (n = 9) was associated with a lower CO (P = 0.01) for the first 24 hours which linearly increased overtime (P = 0.0001). No correlation was found between CO and other factors (P > 0.3 for all).

Conclusions: Comprehensive Aristotle score significantly negatively correlates with CO after the Norwood procedure. A preoperative estimation of the comprehensive Aristotle score, particularly in association with myocardial dysfunction, mechanical ventilation to treat cardiorespiratory failure, atrioventricular valve regurgitation and aortic atresia may help to anticipate a high postoperative morbidity with low cardiac output syndrome.

Abbreviations and Acronyms CO = cardiac output; DO 2 = oxygen delivery; ERO 2 = oxygen extraction ratio; Formula p = pulmonary perfusion; Formula s = systemic perfusion; Formula O 2 = systemic oxygen consumption






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.