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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

02.11.2023 | Reports of Original Investigations

Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study

verfasst von: Ji-Hyun Lee, MD, PhD, André Y. Denault, MD, PhD, William Beaubien-Souligny, MD, PhD, Pyoyoon Kang, MD, Jay Kim, MD, Hee-Won Kim, MD, Sang-Hwan Ji, MD, PhD, Young-Eun Jang, MD, PhD, Eun-Hee Kim, MD, PhD, Hee-Soo Kim, MD, PhD, Jin-Tae Kim, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2023

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Abstract

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.

Hinton RB, Ware SM. Heart failure in pediatric patients with congenital heart disease. 2017; 120: 978–94. https://doi.org/10.1161/circresaha.116.308996CrossRefPubMedPubMedCentral

Hu JT, Yang SS, Lai YC, Shih CY, Chang CW. Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure. World J Gastroenterol 2003; 9: 1828–31. https://doi.org/10.3748/wjg.v9.i8.1828CrossRefPubMedPubMedCentral

Tremblay JA, Beaubien-Souligny W, Elmi-Sarabi M, Desjardins G, Denault AY. Point-of-care ultrasonography to assess portal vein pulsatility and the effect of inhaled milrinone and epoprostenol in severe right ventricular failure: a report of 2 cases. A A Case Rep 2017; 9: 219–23. https://doi.org/10.1213/xaa.0000000000000572CrossRefPubMed

Eljaiek R, Cavayas YA, Rodrigue E, et al. High postoperative portal venous flow pulsatility indicates right ventricular dysfunction and predicts complications in cardiac surgery patients. Br J Anaesth 2019; 122: 206–14. https://doi.org/10.1016/j.bja.2018.09.028CrossRefPubMed

Denault AY, Beaubien-Souligny W, Elmi-Sarabi M, et al. Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery. Anesth Analg 2017; 124: 1109–15. https://doi.org/10.1213/ane.0000000000001812CrossRefPubMed

Beaubien-Souligny W, Benkreira A, Robillard P, et al. Alterations in portal vein flow and intrarenal venous flow are associated with acute kidney injury after cardiac surgery: a prospective observational cohort study. J Am Heart Assoc 2018; 7: e009961. https://doi.org/10.1161/jaha.118.009961CrossRefPubMedPubMedCentral

Guihaire J, Haddad F, Mercier O, Murphy DJ, Wu JC, Fadel E. The right heart in congenital heart disease, mechanisms and recent advances. J Clin Exp Cardiol 2012; 8: 1–11. https://doi.org/10.4172/2155-9880.s8-010CrossRef

Komatsu H, Inui A, Kishiki K, et al. Liver disease secondary to congenital heart disease in children. Expert Rev Gastroenterol Hepatol 2019; 13: 651–66. https://doi.org/10.1080/17474124.2019.1621746CrossRefPubMed

Bolognesi M, Quaglio C, Bombonato G, et al. Splenic Doppler impedance indices estimate splenic congestion in patients with right-sided or congestive heart failure. Ultrasound Med Biol 2012; 38: 21–7. https://doi.org/10.1016/j.ultrasmedbio.2011.10.013CrossRefPubMed

10.

Hulin J, Aslanian P, Desjardins G, Belaïdi M, Denault A. The critical importance of hepatic venous blood flow Doppler assessment for patients in shock. A A Case Rep 2016; 6: 114–20. https://doi.org/10.1213/xaa.0000000000000252CrossRefPubMed

11.

Denault A, Canty D, Azzam M, Amir A, Gebhard CE. Whole body ultrasound in the operating room and intensive care unit. Korean J Anesthesiol 2019; 72: 413–28. https://doi.org/10.4097/kja.19186CrossRefPubMedPubMedCentral

12.

Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason 2020; 20: e205–9. https://doi.org/10.15557/jou.2020.0034

13.

Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004; 30: 1740–6. https://doi.org/10.1007/s00134-004-2259-8CrossRefPubMed

14.

Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–8. https://doi.org/10.1067/mtc.2002.119064CrossRefPubMed

15.

Oh HW, Lee JH, Kim HC, et al. The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial. Anaesthesia 2018; 73: 205–15. https://doi.org/10.1111/anae.14129CrossRefPubMed

16.

Selewski DT, Cornell TT, Heung M, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 2014; 40: 1481–8. https://doi.org/10.1007/s00134-014-3391-8CrossRefPubMed

17.

Xu J, Shen B, Fang Y, et al. Postoperative fluid overload is a useful predictor of the short-term outcome of renal replacement therapy for acute kidney injury after cardiac surgery. Medicine (Baltimore) 2015; 94: e1360. https://doi.org/10.1097/md.0000000000001360CrossRefPubMed

18.

Lee JH, Jung JY, Park SW, et al. Risk factors of acute kidney injury in children after cardiac surgery. Acta Anaesthesiol Scand 2018; 62: 1374–82. https://doi.org/10.1111/aas.13210CrossRefPubMed

19.

Cho YK, Ma JS. Right ventricular failure in congenital heart disease. Korean J Pediatr 2013; 56: 101–6. https://doi.org/10.3345/kjp.2013.56.3.101CrossRefPubMedPubMedCentral

20.

Beghetti M. Echocardiographic evaluation of pulmonary pressures and right ventricular function after pediatric cardiac surgery: a simple approach for the intensivist. Front Pediatr 2017; 5: 184. https://doi.org/10.3389/fped.2017.00184CrossRefPubMedPubMedCentral

21.

DiLorenzo MP, Bhatt SM, Mercer-Rosa L. How best to assess right ventricular function by echocardiography. Cardiol Young 2015; 25: 1473–81. https://doi.org/10.1017/s1047951115002255CrossRefPubMedPubMedCentral

22.

Sun DD, Hou CJ, Yuan LJ, Duan YY, Hou Y, Zhou FP. Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography. PLoS One 2015; 10: e0121408. https://doi.org/10.1371/journal.pone.0121408CrossRefPubMedPubMedCentral

23.

Beaubien-Souligny W, Eljaiek R, Fortier A, et al. The association between pulsatile portal flow and acute kidney injury after cardiac surgery: a retrospective cohort study. J Cardiothorac Vasc Anesth 2018; 32: 1780–7. https://doi.org/10.1053/j.jvca.2017.11.030CrossRefPubMed

24.

Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound 2016; 14: 33. https://doi.org/10.1186/s12947-016-0076-1CrossRefPubMedPubMedCentral

25.

Hacıalioğulları F, Yılmaz F, Yılmaz A, et al. Role of point-of-care lung and inferior vena cava ultrasound in clinical decisions for patients presenting to the emergency department with symptoms of acute decompensated heart failure. J Ultrasound Med 2021; 40: 751–61. https://doi.org/10.1002/jum.15447CrossRefPubMed

26.

Thorpe KE. How to construct regression models for observational studies (and how NOT to do it!). Can J Anesth 2017; 64: 461–70. https://doi.org/10.1007/s12630-017-0833-0CrossRefPubMed

Titel: Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study
verfasst von: Ji-Hyun Lee, MD, PhD
André Y. Denault, MD, PhD
William Beaubien-Souligny, MD, PhD
Pyoyoon Kang, MD
Jay Kim, MD
Hee-Won Kim, MD
Sang-Hwan Ji, MD, PhD
Young-Eun Jang, MD, PhD
Eun-Hee Kim, MD, PhD
Hee-Soo Kim, MD, PhD
Jin-Tae Kim, MD, PhD
Publikationsdatum: 02.11.2023
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2023
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02605-0

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Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study