Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study; [Une pulsatilité de la veine porte plus élevée est associée à de moins bons devenirs cliniques après une chirurgie cardiaque congénitale : une étude de cohorte prospective monocentrique]

被引：0
作者：
Lee J.-H. [1 ]
Denault A.Y. [2 ]
Beaubien-Souligny W. [3 ]
Kang P. [1 ]
Kim J. [4 ]
Kim H.-W. [1 ]
Ji S.-H. [1 ]
Jang Y.-E. [1 ]
Kim E.-H. [1 ]
Kim H.-S. [1 ]
Kim J.-T. [1 ,5 ]
机构：
[1] Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
[2] Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, QC
[3] Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC
[4] Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon
[5] Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul
来源：
Canadian Journal of Anesthesia/Journal canadien d'anesthésie | 2023年 / 70卷 / 12期
关键词：
cardiac surgery; child; Doppler; echocardiography; infant; newborn; ultrasonography; venous congestion; ventricular function;
D O I：
10.1007/s12630-023-02605-0
中图分类号：
学科分类号：
摘要：
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. © 2023, Canadian Anesthesiologists' Society.
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页码：1957 / 1969
页数：12
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