Risk Stratification Management of Pediatric Patients with Prolonged Postoperative Recovery after Total Cavopulmonary　Connection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xu , LI Shoujun , LI Xia , ZENG Min , LI Shengli , ZHANG Yanbo , YAN Jun.

1. PICU，Pediatric　Cardiac Center，Fu Wai Hospital，Chinese Academy of Medical Sciences &;
Peking Union Medical College，Beijing 100037，P. R. China;;
2. Department of Cardiac Surgery，Pediatric Cardiac Center，Fu Wai Hospital，Chinese Academy of Medical Sciences &;
Peking Union Medical College，Beijing 100037，P. R. China;

Corresponding author：

Keywords：

Total cavopulmonary connection; 　Prolonged recovery; 　Risk factor; 　Risk stratification management

DOI：

10.7507/1007-4848.20130082

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Objective To investigate clinical features and risk factors of prolonged postoperative recovery of pediatric　patients in ICU after total cavopulmonary connection（TCPC），provide evidence for risk stratification management strategy，　and enhance their postoperative recovery. Methods We conducted a retrospective analysis of clinical data of 81　patients undergoing TCPC in Fu Wai Hospital from January 2010 to July 2012. Three patients who died postoperatively were　excluded from analysis. Prolonged postoperative recovery was defined as patients whose postoperative mechanical ventilation　time was longer than that of 75% of all the patients. A total of 78 patients were divided into normal recovery group and　prolonged recovery group. There were 59 patients in the normal recovery group including 34 male and 25 female patients with their age of 62.5±20.7 months，and 19 patients in the prolonged recovery group including 11 male and 8 female patients　with their age of 64.8±29.8 months. Perioperative variables were compared between the two groups. Results The average　cardiopulmonary bypass time of all the 81 patients was 107.6±54.1 （33-350） minutes. The average aortic cross-clamping time of 17 patients was 46.4±31.5 （22-143） minutes. Three patients （3.7%） died postoperatively because of severe low cardiac output syndrome and thrombosis in the extracardiac conduit. The mechanical ventilation time and ICU stay were 7.5 hours and 1.6 days respectively in the normal recovery group，which were both significantly prolonged in the prolonged recovery group. Preoperative high hemoglobin level，coexistence of intracardiac anomalies，longer cardiopulmonary bypass time，and non-fenestrated procedure were the main risk factors of prolonged postoperative recovery. Conclusion Early extubation and fast track recovery can be achieved in most of TCPC patients. Risk stratification management strategies may contribute to successful postoperative recovery of critical patients after TCPC.

Citation： WANG Xu,LI Shoujun,LI Xia,ZENG Min,LI Shengli,ZHANG Yanbo,YAN Jun.. Risk Stratification Management of Pediatric Patients with Prolonged Postoperative Recovery after Total Cavopulmonary　Connection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 256-259. doi: 10.7507/1007-4848.20130082 Copy

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12.	Julsrud PR， Weigel TJ， Van Son JA， et al. Influence of ventricular morphology on outcome after the Fontan procedure. Am J Cardiol， 2000， 86 （3）：319-323.
13.	Fedderly RT， Whitstone BN， Frisbee SJ， et al. Factors related to pleural effusions after Fontan procedure in the era of fenestration. Circulation， 2001， 104 （12 Suppl 1）：I148-I151.
14.	Garofalo CA， Cabreriza SE， Quinn TA， et al. Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural　effusions after the Fontan operation. Circulation， 2006， 114（1 Suppl）：I56-I61.
15.	Gupta A， Daggett C， Behera S， et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg， 2004， 127 （6）：1664-1669.
16.	Redington A， Penny D， Shinehoune EA. Pulmonary blood flow　after total cavopulmonary shunt. Br Heart J， 1991， 65 （4）：213-217.
17.	Lofland GK. The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J　Cardiothorac Surg， 2001， 20 （1）：114-118.
18.	Miyaji K， Nagata N， Miyamoto T， et al. Combined therapy with　inhaled nitric oxide and intravenousepoprostenol. For critical pulmonary.
19.	Apostolopoulou SC， Papagiannis J， Rammos S. Bosentan induces clinical， exercise and hemodynamic improvement in a pre-transplant patient with plastic bronchitis after Fontan operation. J Heart Lung Transplant， 2005， 24 （8）：1174-1176.

1. perfusion after the fontan procedure. J Thorac Cardiovas Surg， 2003， 125 （2）：437-438.
2. 　Gaynor JW， Bridges ND， Cohen MI， et al. Predictors of outcome after the Fontan operation：is hypoplastic left heart syndrome still a risk factor ? J Thorac Cardiovasc Surg， 2002， 123 （2）：237-245.
3. 　Van Arsdell GS， Mccrindle BW， Einarson KD， et al. Interventions associated with minimal fontan mortality. Ann Thorac Surg， 2000， 70 （2）：568-574.
4. 　Bridges ND， Mayer JE Jr， Lock JE， et al. Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation， 1992， 86 （6）：1762-1769.
5. 　Lemler MS， Scott WA， Leonard SR， et al. Fenestration improves clinical outcome of the fontan procedure：a prospective， randomized study. Circulation， 2002， 105 （2）：207-212.
6. 　d’udekem Y， Iyengar AJ， Cochrane AD， et al. The fontan procedure：contemporary techniques have improved long-term outcomes. Circulation， 2007， 116 （11 Suppl）：I157-I164.
7. 　Meyer DB， Zamora G， Wernovsky G， et al. Outcomes of the fontan procedure using cardiopulmonary bypass with aortic cross-clamping. Ann Thorac Surg， 2006， 82 （5）：1611-1618.
8. 　Petrossian E， Reddy VM， Mcelhinney DB， et al. Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg， 1999， 117 （4）：688-696.
9. 　Newburger JW， Wypij D， Bellinger DC， et al. Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr， 2003， 143 （1）：67-73.
10. 　Gentles TL， Mayer JE Jr， Gauvreau K， et al. Fontan operation in five hundred consecutive patients：factors influencing early and late outcome. J Thorac Cardiovasc Surg， 1997， 114 （3）：376-391.
11. 　Knott-Craig CJ， Danielson GK， Schaff HV， et al. An analysis of risk factors for early postoperative death or takedown in 702 consecutive　patients from one institution. J Thorac Cardiovasc Surg， 1995， 109 （6）：1237-1243.
12. 　Julsrud PR， Weigel TJ， Van Son JA， et al. Influence of ventricular morphology on outcome after the Fontan procedure. Am J Cardiol， 2000， 86 （3）：319-323.
13. 　Fedderly RT， Whitstone BN， Frisbee SJ， et al. Factors related to pleural effusions after Fontan procedure in the era of fenestration. Circulation， 2001， 104 （12 Suppl 1）：I148-I151.
14. 　Garofalo CA， Cabreriza SE， Quinn TA， et al. Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural　effusions after the Fontan operation. Circulation， 2006， 114（1 Suppl）：I56-I61.
15. 　Gupta A， Daggett C， Behera S， et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg， 2004， 127 （6）：1664-1669.
16. 　Redington A， Penny D， Shinehoune EA. Pulmonary blood flow　after total cavopulmonary shunt. Br Heart J， 1991， 65 （4）：213-217.
17. 　Lofland GK. The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J　Cardiothorac Surg， 2001， 20 （1）：114-118.
18. 　Miyaji K， Nagata N， Miyamoto T， et al. Combined therapy with　inhaled nitric oxide and intravenousepoprostenol. For critical pulmonary.
19. 　Apostolopoulou SC， Papagiannis J， Rammos S. Bosentan induces clinical， exercise and hemodynamic improvement in a pre-transplant patient with plastic bronchitis after Fontan operation. J Heart Lung Transplant， 2005， 24 （8）：1174-1176.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Stratification Management of Pediatric Patients with Prolonged Postoperative Recovery after Total Cavopulmonary　Connection

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk Stratification Management of Pediatric Patients with Prolonged Postoperative Recovery after Total Cavopulmonary Connection

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Risk Stratification Management of Pediatric Patients with Prolonged Postoperative Recovery after Total Cavopulmonary　Connection