May 9, 2006

Impact of preoperative treatment strategies on the early perioperative outcome in neonates with hypoplastic left heart syndrome

The Journal of Thoracic and Cardiovascular Surgery
Jürgen StiehHans Heiner Kramer

Abstract

This study was undertaken to determine the impact of specific intensive care procedures on preoperative hemodynamics, incidence of preoperative organ dysfunction, and in-hospital mortality among neonates with hypoplastic left heart syndrome with pulmonary overcirculation and to assess the influence of the change in preoperative management on early postoperative outcome. In this retrospective evaluation of 72 neonates with classic hypoplastic left heart syndrome and severe pulmonary overcirculation with different preoperative management strategies from 1992 to 1995 and from 1996 to 2000, univariate and multivariate analyses of risk factors were performed with stepwise logistic regression. Among patients with ventilatory and inotropic support from admission until surgery, degree of metabolic acidosis (lowest recorded and prerepair pH values) was significantly higher than among patients who received systemic vasodilators without ventilation before surgery. Preoperative organ dysfunction occurred in 19 of 72 patients (26%), predominantly before 1996; the most significant was hepatic failure in 13 (68%). Lowest recorded and prerepair pH values did not predict the development of organ dysfunction, whereas inotropic medication, lack o...Continue Reading

Mentioned in this Paper

Arterial Blood pH Measurement
Vasodilator [EPC]
Sodium Nitroprusside
Total Peripheral Resistance
Lung
Depressed - Symptom
Hypoplasia
Enterocolitis, Necrotizing
Molecular Oxygen Saturation
Cell Respiration

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