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Evaluation of perfusion index and left ventricular output changes in low cardiac output syndrome after arterial switch operation

Published online by Cambridge University Press:  06 January 2023

Dilek Yavuzcan Öztürk ,
Erkut Öztürk Open the ORCID record for Erkut Öztürk [Opens in a new window] ,
Rahime Tuten Dıkmen ,
Hatice Dilek Ozcanoglu ,
Hamza Halil Toprak ,
Behzat Tuzun ,
İbrahim Cansaran Tanıdır Open the ORCID record for İbrahim Cansaran Tanıdır [Opens in a new window] ,
Ali Can Hatemi  and
Merih Cetinkaya
Dilek Yavuzcan Öztürk*
Affiliation:
Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Erkut Öztürk
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Rahime Tuten Dıkmen
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Hatice Dilek Ozcanoglu
Affiliation:
Department of Anaesthesiology and Reanimation, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Hamza Halil Toprak
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Behzat Tuzun
Affiliation:
Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
İbrahim Cansaran Tanıdır
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Ali Can Hatemi
Affiliation:
Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Merih Cetinkaya
Affiliation:
Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
*
Author for correspondence: Dilek Yavuzcan Ozturk, MD, Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Başakşehir Mahallesi G-434 Caddesi No: 2L Başakşehir, Istanbul, Turkey. Tel: +90 212 909 60 00; Fax: +90 212 909 60 00. E-mail: drdileky@gmail.com
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Abstract

Introduction:

Transposition of great arteries is one of newborns' most common cyanotic CHDs, and its treatment is arterial switch operation in the first days of life. Low cardiac output syndrome may develop in the early postoperative period. In this study, we evaluated perfusion index and left ventricular output blood flow changes in patients who underwent arterial switch operation and developed low cardiac output syndrome.

Methods:

This study was conducted prospectively in newborns with transposition of great arteries who underwent arterial switch operation between 1st August 2020 and 1st August 2022. Low cardiac output syndrome score and left ventricular output were investigated. Initially, 6th, 12th, 18th, and 24th hour perfusion index and left ventricular output values of patients with and without low cardiac output syndrome were recorded. The results were evaluated statistically.

Results:

A total of 60 patients were included in the study. Sex distribution was equal. The median age at the time of surgery was 5 days (interquartile range 3–7 days), and the median weight was 3.1 kg (interquartile range 2.9–3. 4). Low cardiac output syndrome was detected in 30% (n = 18) of cases. The median perfusion index of patients who developed low cardiac output syndrome was significantly lower at the 12th, 18th, and 24th hours (p < 0.05) (0.99 versus 1.25, 0.86 versus 1.21, and 0.96 versus 1.33, respectively). Similarly, the median left ventricular output of patients who developed low cardiac output syndrome was significantly lower at 12th, 18th, and 24th hours (p < 0.05) (95 versus 110 ml/kg/min, 89 versus 109 ml/kg/min, and 92 versus 112 ml/kg/min, respectively). There was a significant correlation between perfusion index values and left ventricular output at all measurements (r > 0.500, p < 0.05).

Conclusion:

Perfusion index and left ventricular output measurements decreased in newborns who developed low cardiac output syndrome after arterial switch operation, especially at 12th and 18th hours. Serial perfusion index and left ventricular output measurements can be instructive in predicting low cardiac output syndrome development.

Keywords

Newborntransposition of great arteriesarterial switch operationperfusion indexlow cardiac output syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2196 - 2202
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Altin, FH, Sengul, FS, Yildiz, O, et al. Impact of coronary artery anatomy in arterial switch procedure on early mortality and morbidity. Congenit Heart Dis. 2016; 11: 115–121.10.1111/chd.12295CrossRefGoogle ScholarPubMed
Hoffman, TM, Wernovsky, G, Atz, AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.10.1161/01.CIR.0000051365.81920.28CrossRefGoogle ScholarPubMed
Ulate, KP, Yanay, O, Jeffries, H, Baden, H, Di Gennaro, JL, Zimmerman, J. An elevated low cardiac output syndrome score ıs associated with morbidity in ınfants after congenital heart surgery. Pediatr Crit Care Med 2017; 18: 26–33.10.1097/PCC.0000000000000979CrossRefGoogle ScholarPubMed
Alderliesten, T, Lemmers, PM, Baerts, W, Groenendaal, F, van Bel, F. Perfusion index in preterm infants during the first 3 days of life: reference values and relation with clinical variables. Neonatology 2015; 107: 258–265.10.1159/000370192CrossRefGoogle ScholarPubMed
Dawson, JA, Kamlin, CO, Wong, C, et al. Oxygen saturation and heart rate during delivery room resuscitation of infants <30 weeks' gestation with air or 100% oxygen. Arch Dis Child Fetal Neonatal 2009; 94: F87–F91.10.1136/adc.2008.141341CrossRefGoogle ScholarPubMed
Banait, N, Suryawanshi, P, Malshe, N, Nagpal, R, Lalwani, S. Cardiac blood flow measurements in stable full term small for gestational age neonates. J Clin Diagn Res. 2013; 7: 1651–1654.Google ScholarPubMed
Corsini, I, Cecchi, A, Coviello, C, Dani, C. Perfusion index and left ventricular output correlation in healthy term infants. Eur J Pediatr 2017; 176: 1013–1018.10.1007/s00431-017-2920-1CrossRefGoogle ScholarPubMed
Mertens, L, Seri, I, Marek, J, et al. Writing group of the American Society of Echocardiography (ASE), European Association of Echocardiography (EAE), Association for European Pediatric Cardiologists (AEPC). Targeted neonatal echocardiography in the neonatal intensive care unit: practice guidelines and recommendations for training. Eur J Echocardiogr 2011; 12: 715–736.10.1093/ejechocard/jer181CrossRefGoogle ScholarPubMed
Valencia, E, Staffa, SJ, Nathan, M, et al. Hyperlactataemia as a predictor of adverse outcomes post-cardiac surgery in neonates with congenital heart disease. Cardiol Young 2021; 31: 1401–1406.10.1017/S1047951121000263CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010; 11: 234–238.10.1097/PCC.0b013e3181b806fcCrossRefGoogle ScholarPubMed
Wernovsky, G, Wypij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.10.1161/01.CIR.92.8.2226CrossRefGoogle ScholarPubMed
Pérez-Navero, JL, Merino-Cejas, C, Ibarra de la Rosa, I, et al. Evaluation of the vasoactive-inotropic score, mid-regional pro-adrenomedullin and cardiac troponin I as predictors of low cardiac output syndrome in children after congenital heart disease surgery. Med Intensiva (Engl Ed) 2019; 43: 329–336.10.1016/j.medin.2018.04.005CrossRefGoogle ScholarPubMed
Butts, RJ, Scheurer, MA, Atz, AM, Zyblewski, SC, Hulsey, TC, Bradley, SM. Graham EM.Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol 2012; 33: 633–638.10.1007/s00246-012-0193-zCrossRefGoogle Scholar
Parr, GV, Blackstone, EH, Kirklin, JW. Cardiac performance and mortality early after intracardiac surgery in infants and young children. Circulation 1975; 51: 867–874.10.1161/01.CIR.51.5.867CrossRefGoogle ScholarPubMed
Charpie, JR, Dekeon, MK, Goldberg, CS, Mosca, RS, Bove, EL, Kulik, TJ. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000; 120: 73–80.10.1067/mtc.2000.106838CrossRefGoogle ScholarPubMed
Kroese, JK, van Vonderen, JJ, Narayen, IC, Walther, FJ, Hooper, S, te Pas, AB. The perfusion index of healthy term infants during transition at birth. Eur J Pediatr 2016; 175: 475–479.10.1007/s00431-015-2650-1CrossRefGoogle ScholarPubMed
Hu, XJ, Ding, JX, Wang, Y, et al. Peripheral perfusion index percentiles for healthy newborns by gestational age and sex in China. Sci Rep 2020; 10: 4213.10.1038/s41598-020-60741-9CrossRefGoogle ScholarPubMed
Elshal, MM, Hasanin, AM, Mostafa, M, Gamal, RM. Plethysmographic peripheral perfusion ındex: could ıt be a new vital sign? Front Med (Lausanne) 2021; 8: 651909.10.3389/fmed.2021.651909CrossRefGoogle ScholarPubMed
Takahashi, S, Kakiuchi, S, Nanba, Y, Tsukamoto, K, Nakamura, T, Ito, Y. The perfusion index derived from a pulse oximeter for predicting low superior vena cava flow in very low birth weight infants. J. Perinatol 2010; 30: 265–269.10.1038/jp.2009.159CrossRefGoogle ScholarPubMed
Granelli, A, Ostman-Smith, I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 2007; 96: 1455–1459.10.1111/j.1651-2227.2007.00439.xCrossRefGoogle ScholarPubMed
Mostafa, H, Shaban, M, Hasanin, A, et al. Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients. BMC Anesthesiol 2019; 19: 242.10.1186/s12871-019-0917-1CrossRefGoogle ScholarPubMed
Janaillac, M, Beausoleil, TP, Barrington, KJ, et al. Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life. Eur J Pediatr 2018; 177: 541–550.10.1007/s00431-018-3096-zCrossRefGoogle ScholarPubMed