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Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular septal defects repair: A retrospective cohort study

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Abstract
Background Ventricular-arterial coupling is the ratio of arterial elastance to ventricular end-systolic elastance. Aims The objective of this study was to determine the clinical implication of intraoperative ventricular-arterial coupling derived from the pressure-area relationship using transesophageal echocardiography. Methods This retrospective study reviewed the medical records of 72 pediatric patients with ventricular septal defects who underwent corrective surgery with cardiopulmonary bypass. The single-beat modified method was used to assess ventricular-arterial coupling. Logistic regression analyses were performed to determine the correlation between ventricular-arterial coupling and early postoperative outcomes, including the maximum vasoactive-inotropic score, length of mechanical ventilation, and length of hospital stay. Results Ventricular-arterial coupling after cardiopulmonary bypass significantly increased (from 1.0 +/- 0.4 to 1.4 +/- 0.8, p < .001), indicating a disproportionate increase in the arterial elastance index (from 11.5 +/- 5.1 to 19.8 +/- 7.5 mmHg/cm(2)/m(2), p < .001) compared with the ventricular end-systolic elastance index (from 13.0 +/- 6.9 to 16.9 +/- 9.0 mmHg/cm(2)/m(2), p < .001). Logistic regression analyses revealed that high postoperative ventricular-arterial coupling was independently associated with higher postoperative maximum vasoactive-inotropic score (>10; odds ratio [OR], 8.04; 95% confidence interval [CI], 1.38-46.85, p = .020), longer postoperative mechanical ventilation (>15 h; OR: 11.00; 95% CI: 1.26-96.45, p = .030), and longer postoperative hospital stay (>7 days; OR: 2.98; 95% CI: 1.04-8.58, p = .043). Conclusions Ventricular-arterial coupling can be easily obtained from the intraoperative transesophageal echocardiography in pediatric patients undergoing ventricular septal defects repair. High postoperative ventricular-arterial coupling is strongly associated with worse early postoperative outcomes. Ventricular-arterial coupling shows promise as an intraoperative analysis tool that can provide insight into the impact of interventions on cardiovascular performance and identify potential targets for treatment in this population.
Author(s)
오지미이병두정다운신원정윤태진박천수최은석송인경
Issued Date
2021
Type
Article
Keyword
cardiac surgeryChildrencongenitalCoronary artery bypassechocardiographyGenetic disordersHealth aspectsheart defectsinotropic agentsMedical researchMedical recordsMedicineExperimentalPediatricspositive cardiacPostoperative periodRegression analysisVntricular septal defects
DOI
10.1111/pan.14277
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8153
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2561924543&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Clinical%20implication%20of%20intraoperative%20ventricular-arterial%20coupling%20in%20pediatric%20patients%20undergoing%20ventricular%20septal%20defects%20repair:%20A%20retrospective%20cohort%20study&amp;offset=0&amp;pcAvailability=true
Publisher
PEDIATRIC ANESTHESIA
Location
미국
Language
영어
ISSN
1155-5645
Citation Volume
31
Citation Number
11
Citation Start Page
1216
Citation End Page
1224
Appears in Collections:
Medicine > Medicine
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