Résumé
Objective: To assess outcomes and factors influencing outcomes in neonates requiringcardiac surgery in India. Methods: This study reports on review of hospital data from atertiary care cardiac surgical institute from January-2009 to December-2015. Results: A totalof 200 neonates were included; of them, 5% of the cases were antenatally diagnosed andmost of them had unmonitored transport (111, 55.5%). The overall mortality rate was 13.5%,(n=27) and 178 (89%) underwent complete defect repair. There was a significant associationof mortality with shock, the number of inotropes, intra-operative procedure, residual lesion,aortic cross-clamp and deep hypothermic circulatory arrest time (all P<0.05). Logisticregression analysis showed ventilation duration, cardiac-bypass time, shock, and residualcardiac lesion as independent predictors of mortality. Conclusion: Cardiac defects werefound to have late detection and most transports were unmonitored. Complete surgical repairand shorter cardiac bypass time can potentially improve neonatal cardiac surgical outcomes
Résumé
Introduction: Incidence of junctional ectopic tachycardia (JET) after repair of tetralogy of Fallot (TOF) is 5.6–14%. Dexmeditomidine is a α-2 adrenoceptor agonist modulates the release of catecholamine, resulting in bradycardia and hypotension. These effects are being explored as a therapeutic option for the prevention of perioperative tachyarrhythmia. We undertook this study to examine possible preventive effects of dexmedetomidine on postoperative JET and its impact on the duration of ventilation time and length of Intensive Care Unit stay. Methods: After obtaining approval from the hospitals ethics committee and written informed consent from parents, this quasi-randomized trial was initiated. Of 94 patients, 47 patients received dexmedetomidine (dexmedetomidine group) and 47 patients did not receive the drug (control group). Results: Dexmedetomidine group had more number of complex variants like TOF with an absent pulmonary valve or pulmonary atresia (P = 0.041). Hematocrit on cardiopulmonary bypass (CPB), heart rate while coming off from CPB and inotrope score was significantly low in the dexmedetomidine group compared to control group. The incidence of JET was significantly low in dexmedetomidine group (P = 0.040) compared to control group. Conclusions: Dexmedetomidine may have a potential benefit of preventing perioperative JET.