ABSTRACT
BACKGROUND: The optimal preoperative hemoglobin (Hb) level is difficult to define in children with cyanotic congenital heart disease (CHD) due to hypoxemia-induced secondary erythrocytosis. This retrospective study integrated preoperative Hb and pulse oxygen saturation (SpO2) using the product of Hb × SpO2 to predict postoperative outcomes in children with cyanotic CHD. PATIENTS AND METHODS: Children aged <18 years undergoing cardiac surgery with cyanotic CHD were included. The cutoff value of Hb × SpO2 was the age-adjusted lower limit of normal Hb (aaHb) in healthy children. The main outcomes were in-hospital death and the composite outcome of severe postoperative events. Multivariate logistic regression analysis and propensity score matching analysis were used to adjust for important confounders. RESULTS: The presence of preoperative Hb × SpO2 < aaHb was observed in 21.6% of cyanotic children (n = 777). Children with Hb × SpO2 < aaHb had higher in-hospital mortality (12.5% vs. 4.6%, P < 0.001) and composite outcome incidence (69.6% vs. 32.3%, P < 0.001) than those with Hb × SpO2 ≥ aaHb. After propensity score matching, 141 pairs of children were successfully matched. Multivariate analysis showed that preoperative Hb × SpO2 < aaHb was significantly associated with the composite outcome in the entire population (odds ratio = 4.092, 95% confidence interval = 2.748-6.095, P < 0.001) and the matched cohorts (odds ratio = 2.277, 95% confidence interval = 1.366-3.795, P = 0.002). CONCLUSION: Our results suggest that a preoperative Hb × SpO2 value below the lower limit of normal hemoglobin is a prognostic factor in cyanotic children undergoing cardiac surgery and is a potential criterion to evaluate preoperative anemia in this population.
ABSTRACT
The development of minimally invasive surgery has created a demand for ideal medical adhesives exhibiting biocompatibility, biodegradability, antimicrobial activity, and strong adhesion to tissues in wet environments. However, as clinically approved surgical tissue glues suffer from poor adhesion activation, limited adhesion strength, and toxicity, novel tissue glues are highly sought after. Herein, a mussel-inspired injectable hydrogel was prepared from catechol- and methacrylate-modified chitosan/gelatin and shown to exhibit biocompatibility, inherent antimicrobial activity, and good adhesion to wet tissues. Moreover, as this gel could be applied onto tissue surfaces and cured in situ within seconds of body contact by a biocompatible and multifunctional redox initiator (H2O2-ascorbic acid), it was concluded to be a promising surgical sealant and wound dressing (even for infected wounds) accelerating wound healing.
