Canadian Journal of Anesthesia ( IF 3.4 ) Pub Date : 2023-11-02 , DOI: 10.1007/s12630-023-02605-0
Ji-Hyun Lee 1 , André Y Denault 2 , William Beaubien-Souligny 3 , Pyoyoon Kang 1 , Jay Kim 4 , Hee-Won Kim 1 , Sang-Hwan Ji 1 , Young-Eun Jang 1 , Eun-Hee Kim 1 , Hee-Soo Kim 1 , Jin-Tae Kim 1, 5
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Purpose
Increased portal venous flow pulsatility is associated with major complications after adult cardiac surgery. Nevertheless, no data are available for pediatric patients with congenital heart disease. We hypothesized that Doppler parameters including portal flow pulsatility could be associated with postoperative outcomes in children undergoing various cardiac surgeries.
Methods
We conducted a prospective observational cohort study in children undergoing congenital cardiac surgery. We obtained postoperative portal, splenic, and hepatic venous Doppler data and perioperative clinical data including major postoperative complications. Portal and splenic venous flow pulsatility were calculated. We evaluated the association between venous Doppler parameters and adverse outcomes. The primary objective was to determine whether postoperative portal flow pulsatility could indicate major complications following congenital heart surgery.
Results
In this study, we enrolled 389 children, 74 of whom experienced major postoperative complications. The mean (standard deviation) portal pulsatility (44 [30]% vs 25 [14]%; 95% confidence interval [CI] for mean difference, 12 to 26; P < 0.001] and splenic pulsatility indices (41 [30]% vs 26 [16]%; 95% CI, 7 to 23; P < 0.001) were significantly higher in children with postoperative complications than in those without complications. The portal pulsatility index was able to help identify postoperative complications in biventricular patients and univentricular patients receiving bidirectional cavopulmonary shunt whereas it did not in other univentricular patients. An increased postoperative portal pulsatility index was significantly associated with major complications after pediatric cardiac surgery (odds ratio, 1.40; 95% CI, 1.29 to 1.91; P < 0.001).
Conclusions
Higher portal venous pulsatility is associated with major postoperative complications in children undergoing cardiac surgery. Nevertheless, more data are needed to conclude the efficacy of portal venous pulsatility in patients with univentricular physiology.
Study registration
ClinicalTrials.gov (NCT03990779); registered 19 June 2019.
中文翻译:
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较高的门静脉搏动与先天性心脏病手术后较差的临床结果相关:一项单中心前瞻性队列研究
目的
门静脉血流搏动增加与成人心脏手术后的主要并发症相关。然而,没有先天性心脏病儿科患者的数据。我们假设包括门脉血流搏动在内的多普勒参数可能与接受各种心脏手术的儿童的术后结果相关。
方法
我们对接受先天性心脏手术的儿童进行了一项前瞻性观察队列研究。我们获得了术后门静脉、脾脏和肝静脉多普勒数据以及围手术期临床数据,包括主要术后并发症。计算门静脉和脾静脉血流搏动。我们评估了静脉多普勒参数与不良结果之间的关联。主要目的是确定术后门脉血流搏动是否可以表明先天性心脏病手术后的主要并发症。
结果
在这项研究中,我们招募了 389 名儿童,其中 74 名经历了严重的术后并发症。门脉搏动平均值(标准差)(44 [30]% vs 25 [14]%;平均差的 95% 置信区间 [CI],12 至 26; P < 0.001] 和脾搏动指数(41 [30]%) vs 26 [16]%;95% CI,7 至 23; P < 0.001)在有术后并发症的儿童中显着高于无并发症的儿童。门脉搏动指数能够帮助识别双心室患者和单心室患者的术后并发症。接受双向腔肺分流术的患者,而其他单心室患者则没有。术后门脉搏动指数增加与小儿心脏手术后的主要并发症显着相关(比值比,1.40;95% CI,1.29至1.91; P < 0.001)。
结论
较高的门静脉搏动与接受心脏手术的儿童的主要术后并发症有关。然而,需要更多数据来得出门静脉搏动对单心室生理患者的疗效。
学习注册
ClinicalTrials.gov (NCT03990779); 2019 年 6 月 19 日注册。