Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular septal defects repair: A retrospective cohort study
- 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)
- 오지미; 이병두; 정다운; 신원정; 윤태진; 박천수; 최은석; 송인경
- Issued Date
- 2021
- Type
- Article
- Keyword
- cardiac surgery; Children; congenital; Coronary artery bypass; echocardiography; Genetic disorders; Health aspects; heart defects; inotropic agents; Medical research; Medical records; Medicine; Experimental; Pediatrics; positive cardiac; Postoperative period; Regression analysis; Vntricular 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&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Clinical%20implication%20of%20intraoperative%20ventricular-arterial%20coupling%20in%20pediatric%20patients%20undergoing%20ventricular%20septal%20defects%20repair:%20A%20retrospective%20cohort%20study&offset=0&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
-
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