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Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.
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Objective To analyze the risk factors associated with multiple organ dysfunction syndrome (MODS) in children after cardiopulmonary bypass (CPB).Methods Between Jan 2001 and Dec 2010,1 899 patients undergoing open heart surgery were reviewed retrospectively according to the presence or absence of MODS.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Thirty-five patients (1.84％) developed MODS,the mortality for MODS was 51.43％ (18/35).Univariate risk factors included complex congenital heart disease,perioperative unexpected events,CPB time,aortic cross-clamping time,mechanical ventilation time,and postoperative spsis.Multivariate logistic regression analysis identified that complex congenital heart disease,perioperative unexpected events,CPB time ＞ 180 min,postoperative spsis were risk factors.Conclusion The results suggest that the patients with MODS risk factors described above need more careful peri and post operative surveillance and preventive management.
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Objective To evaluate the effects of inhaled nitric oxide (iNO) in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure(mPAP) decreased from (38.0 ±3.2) mm Hg to (28.0 ±2.1) mm Hg,pulmonary vascular resistance (PVR) decreased from (62.2 ±6.7) kPa/(L·S) to (49.9 ±5.6) kPa/(L·S) ,PaO2/FiO2increased from (67.0 ±30. 1 ) mm Hg to (92. 6 ±25.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.
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Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.
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Objective To study the effects of different levels of hemodilution during extracorporeal circulation(ECC) on the concentration of lactic acid and postoperative outcome in children with congenital heart disease.Methods Sixty children with congenital heart diseases undergoing open heart surgery with ECC were randomly divided into three groups: groupⅠ(n=20) underwent mild hemodilution [Hb(80—90)g/L],groupⅡ(n=20) with medium hemodilution [Hb(70—79)g/L],and groupⅢ(n=20) with deep hemodilution [Hb(60—69)g/L].The concentration of lactic acid and PaO_2 in groupⅡ and group Ⅲ were compared with groupⅠ before ECC,during ECC,after ECC and 24h after the operation.The rate of homologous transfusion during ECC and the postoperative dosage of furosemide were also compared among the three groups.Results The concentrations of lactic acid and PaO2 in the three groups were all within normal range before ECC,during ECC,after ECC and 24h after operation.The homologous transfusion rate during ECC were lower in groupⅡ(30%)and groupⅢ(15%) compared to that of groupⅠ(50%)(P
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30% after ANH) and blood volume was maintained with crystalloid and colloid (1 : 3) . The preoperatively collected blood and the blood salvaged during operation were infused back to the patient after CPB. The operations were performed under CPB with moderate hypothermia. In patients undergoing atrial or ventricular septal defect tranexamic acid 20 ml-kg-1 was given and in other patients aprotinin 5 000 000 U was given. Hb, Hct and platelet count (PLT) were measured and recorded before operation, after ANH and 24h after operation. The volume of RBC salvaged during operation, CPB time and the volume of chest tube drainage at 24h after operation, the volume of whole blood, plasma, packed RBC, cryoprecipitate and platelet transfused and hospitalization time were also recorded. Results The demographic data were comparable between the two groups. There was no significant difference in CPB time and the total days of hospitalization between the two groups. The Hb at 24h after operation was significantly higher in group A +C [(122.2+18.8)g/L] than that in group C [(112.3+15.6)g/L] (P
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To evaluate APTT for monitoring heparin neutralization and rebound following CPB. Method: Twenty patients undergoing cardiac valve replacement were randomly selected, APTT and activated clotting time (ACT) were measured 10 minutes following protamine in 0.5:1,0.7:1and 1:1 ratio to total heparin administered, and 3 and 6 hours after 1:1 ratio. Result: After the neutralization of the heparin/protamine at ratio of 0.5:1, the further doses of protamine (0.7: 1,1:1)decreased APTT markedly (P0.05). APTT with 0.5:1 or 0.7:1 ratio neutralization decreased significantly after in vitro protamine titration (P0.05). Conclusion= APTT is a better assay for monitoring both inadequate reversa. of heparin and heparin rebound,and is more sensitive to minimal dose heparin than ACT. The dose ratio of protamine to heparin at 1:1 may reverse heparin effect completely.
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Effects of epidural block on stress response during eardiopulmonary bypass were studied. Twenty patients, undergoing open heart surgery with cardiopulmonary bypass, were randomly divided into two groups:the control group with intravenous high-dose fentanyl and enflurane inhalation (1%-1.5%);the tested group with epidural block and enflurane inhalation (0.5%-1%). The plasma norepinephine (NE) and epinephrine (E) concentrations were higher in group control than those in tested group during and after CPB,even at the end of operation (P
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Objective To assess the effect of leukocyte fihration on systemic inflammatory response to cardiopulmonary bypass.Methods Twelve mongrel dogs weighing 25-30 kg were randomly divided into 2 groups (n=6 each):control group(C)and leukocyte depletion group(LD).The dogs were anesthetized with intraperitoneal pentobarbital 25 mg?kg~(-1).The trachea was intubated.The arterial line of CPB was connected with aortic cannula and the venous line with a cannula inserted into right atrium.The leukocyte-depletion filter LD-1 was positioned in the venous line of CPB circuit.Aorta was clamped at 10 min of CPB and St.Thomas cardioplegic solution 20 ml?kg~(-1) was injected into the root of aorta.The filter was used for 5 min starting from 2 min of CPB. Aorta was clamped for 60 min.Blood samples were taken from femoral vein before CPB(T_0,baseline), immediately after aortic clamping(T_1)at 30 min of aortic clamping(T_2)5 min after aortic unclamping(T_3)at the termination of CPB(T_4)and 2 h after termination of CPB(T_5)for leukocyte count and determination of plasma L-selectin,IL-6 and IL-8 concentrations and MPO activity.The IL-6 and IL-8 concentrations in the filter LD-1 were measured at 30,60 and 90 rain after leukocyte filtration.The membrane of filter LD-1 was taken at 90 min after filtration for microscopic examination.Results The leukocyte count was significantly lower at T_1 in LD group than in C group.The plasma L-selectin,IL-6,IL-8 concentrations and MPO activity were significantly increased during CPB as compared to the baseline at T_0 in both groups but were lower at T_5 in LD group than in C group.The IL-6 and IL-8 concentrations in LD-1 filter were increased at 60 and 90 min after filtration as compared to those at 30 min.The filter membrane was covered with enormous number of leukocytes.Conclusion Leukocyte filtration can decrease systemic inflammatory response to CPB in dogs.