Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors
Leonardo Leiria de Moura da Silva *
Department of Anaesthesia, The Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Liverpool, United Kingdom and b Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil and Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), RS, Brazil.
Bibiana de Borba Telles
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Jamile Dutra Correia
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Daniélle Bernardi Silveira
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Ernani Bohrer da Rosa
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Maurício Rouvel Nunes
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Diego da Costa Cardoso
Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), RS, Brazil.
Daniel Hoyer de Carvalho Barcellos
Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), RS, Brazil.
Paulo Ricardo Gazzola Zen
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil and Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), RS, Brazil and Clinical Genetics, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
Rafael Fabiano Machado Rosa
Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil and Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), RS, Brazil and Clinical Genetics, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors.
Study Design: Cross-sectional cohort study with 307 pediatric patients.
Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years)
Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of <0.05 were considered significant.
Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P < 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P < 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P < 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings.
Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.
Keywords: Congenital heart defects, cardiopulmonary bypass, aortic cross-clamping, high resolution karyotype, fluorescent in situ hybridization, prognostic factors
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References
Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(6): 814–22.
Robich M, Ryzhov S, Kacer D, Palmeri M, Peterson SM, Quinn RD, et al. Prolonged cardiopulmonary bypass is associated with endothelial glycocalyx degradation. J Surg Res. 2020;251:287–95.
Madhavan S, Chan S-P, Tan W-C, Eng J, Li B, Luo H-D, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino). 2018;59(2): 274–81.
Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med. 2003;31(1):28–33.
Gillespie M, Kuijpers M, Van Rossem M, Ravishankar C, Gaynor JW, Spray T, et al. Determinants of intensive care unit length of stay for infants undergoing cardiac surgery. Congenit Heart Dis. 2006; 1(4):152–60.
Pagowska-Klimek I, Pychynska-Pokorska M, Krajewski W, Moll JJ. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardiothorac Surg. 2011;40(1):179–84.
Kozik DJ, Tweddell JS. Characterizing the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg. 2006;81(6):S2347-54.
Durandy Y. Minimizing systemic inflammation during cardiopulmonary bypass in the pediatric population. Artif Organs. 2014;38(1):11–8.
Babik B, Asztalos T, Peták F, Deák ZI, Hantos Z. Changes in respiratory mechanics during cardiac surgery. Anesth Analg. 2003;96(5):1280–7.
Simonato M, Baritussio A, Carnielli VP, Vedovelli L, Falasco G, Salvagno M, et al. Influence of the type of congenital heart defects on epithelial lining fluid composition in infants undergoing cardiac surgery with cardiopulmonary bypass. Pediatr Res. 2018;83(4):791–7.
Rosa RFM, Pilla CB, Pereira VLB, Flores JAM, Golendziner E, Koshiyama DB, et al. 22q11.2 deletion syndrome in patients admitted to a cardiac pediatric intensive care unit in Brazil. Am J Med Genet A. 2008;146A(13):1655–61.
Correia JD, da Rosa EB, Silveira DB, Grapiglia CG, Canabarro ST, Waterkemper R, et al. Major Extracardic Malformations among patients with congenital heart defects. Int. J Cardiol. 2016;214:154–6.
Floriani MA, Glaeser AB, Dorfman LE, Agnes G, Rosa RFM, Zen PRG. GATA 4 Deletions Associated with Congenital Heart Diseases in South Brazil. J Pediatr Genet. 2021;10(2):92–7.
Zen TD, Rosa RFM, Zen PRG, Trevisan P, da Silva AP, Ricachinevsky CP, et al. Gestational and family risk factors for carriers of congenital heart defects in southern Brazil. Pediatr Int. 2011; 53(4):551–7.
Botto LD, Correa A, Erickson JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics. 2001; 107(3):E32.
Atli EI, Atli E, Yalcintepe S, Demir S, Kalkan R, Akurut C, et al. Investigation of genetic alterations in congenital heart diseases in prenatal period. Glob Med Genet. 2022;09(01):029–33.
Markousis-Mavrogenis G, Giannakopoulou A, Belegrinos A, Pons MR, Bonou M, Vartela V, et al. Cardiovascular magnetic resonance imaging patterns in rare cardiovascular diseases. J Clin Med. 2022;11(21).
Hadi AA. Clinical Study of Ebstein’s anomaly patients who had pre-operative MRI & underwent surgery in IKN. Journal of Cardiovascular Disease Research. 2020;11(2):224-231.
Attenhofer Jost CH, Edmister WD, Julsrud PR, Dearani JA, Savas Tepe M, Warnes CA, et al. Prospective comparison of echocardiography versus cardiac magnetic resonance imaging in patients with Ebstein’s anomaly. Int J Cardiovasc Imaging. 2012;28(5):1147–59.
Wu K, Meng B, Wang Y, Zhou X, Zhang S, Ding Y. Impact of miniaturized cardiopulmonary bypass circuits on ultrafiltration during congenital heart surgery. Perfusion. 2021;36(8):832–8.
Silva LL de M da, Andres AJ de B, Senger R, Stuermer R, Godoy MC de M de, Correa EFM, et al. Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc. 2013;28(2):183–9.
Alicandro T, Putotto C, Calcagni G, Unolt M, Mastromoro G, Digilio MC, et al. Impact of genetic studies on comprehension and treatment of congenital heart disease. Prog Pediatr Cardiol. 2018;51:31–6.
Anaclerio S, Di Ciommo V, Michielon G, Digilio MC, Formigari R, Picchio FM, et al. Conotruncal heart defects: impact of genetic syndromes on immediate operative mortality. Ital Heart J. 2004;5(8):624–8.
Hu Y, Zhu X, Yang Y, Mo X, Sheng M, Yao J, et al. Incidences of micro-deletion/duplication 22q11.2 detected by multiplex ligation-dependent probe amplification in patients with congenital cardiac disease who are scheduled for cardiac surgery. Cardiol Young. 2009; 19(2):179–84.
Agergaard P, Olesen C, Østergaard JR, Christiansen M, Sørensen KM. The prevalence of chromosome 22q11.2 deletions in 2,478 children with cardiovascular malformations. A population-based study. Am J Med Genet A. 2012;158A(3):498–508.
Agarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2014;148(2): 609-16.e1.
Vidal Melo MF. Clinical respiratory physiology of the neonate and infant with congenital heart disease. Int Anesthesiol Clin. 2004;42(4):29–43.
Johnson MH. Functional brain development in humans. Nat Rev Neurosci. 2001;2(7):475–83.