Low Cardiac Output Syndrome After Cardiac 
Surgery: A Life-Threatening Condition from the 
Perspective of Pediatric Intensivists

Aslan, Nagehan; yildizdas, dincer

doi:10.5543/tkda.2022.21212

Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists

Nagehan ASLAN, (Malatya Eğitim ve Araştırma Hastanesi, Çocuk Yoğun Bakım Anabilim Dalı, Malatya, Türkiye)

Dinçer YILDIZTAŞ (Çukurova Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım Anabilim Dalı, Adana, Türkiye)

Türk Kardiyoloji Derneği Arşivi

4 0

Yıl: 2022 Cilt: 50 Sayı: 4 Sayfa Aralığı: 284 - 292 Metin Dili: İngilizce DOI: 10.5543/tkda.2022.21212 İndeks Tarihi: 07-07-2022

Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists

Öz:

Low cardiac output syndrome is a clinical picture insourcing from insufficient oxygen supply to tissues so as to meet the metabolic demand, myocardial dysfunction, and cardiovascular insufficiency. Low cardiac output syndrome is seen in nearly 25% of pediatric patients who underwent corrective or palliative surgery due to congenital heart defects. It is a clinical condition occurring typically 6-18 hours after surgery in pediatric patients undergoing cardiac surgery and causes organ failure, prolonged hospital and intensive care hospitalization time, increased resource utilization, and mortality. The identification and correct management of this serious complication in the early period is very important. However, there is no clear consensus or consensus report on the follow-up of this patient group and the definition of low cardiac output syndrome. Clinicians generally produced low cardiac output syndrome definitions according to their own approach. In this review, we aim to draw attention to low cardiac output syndrome and hope to summarize the pathophysiology, etiology, clinical definition, and treatment options of low cardiac output syndrome as a life-threatening condition in pediatric intensive care unit.

Anahtar Kelime:

Kardiyak Cerrahi Sonrası Düşük Kardiyak DebiSendromu: Çocuk Yoğun Bakım UzmanlarınınPerspektifinden Hayatı Tehdit Eden Bir Durum

Öz:

Düşük kardiyak debi sendromu, metabolik ihtiyacı karşılamak için dokulara yetersiz oksijen sunumu, miyokart disfonksiyonu ve kardiyovasküler yetmezlikten kaynaklanan bir klinik tablodur. Doğuştan kalp hastalıkları nedeniyle düzeltici veya palyatif cerrahi uygulanan pediatrik hastaların yaklaşık %25’inde düşük kardiyak debi sendromu görülür. Kalp cerrahisi geçiren pediatrik hastalarda ameliyattan tipik olarak 6-18 saat sonra ortaya çıkan ve organ yetmezliğine, hastanede ve yoğun bakımda yatış süresinin uzamasına, kaynak kullanımının artmasına ve mortaliteye neden olan bir klinik durumdur. Bu ciddi komplikasyonun erken dönemde saptanması ve doğru yönetimi çok önemlidir. Ancak bu hasta grubunun takibi ve düşük kardiyak debi sendromu tanımı konusunda net bir fikir birliği veya konsensus raporu bulunmamaktadır. Klinisyenler genellikle kendi yaklaşımlarına göre düşük kardiyak debi sendromu tanımlarını üretmişlerdir. Bu derlemede, düşük kardiyak debi sendromuna dikkat çekmeyi ve çocuk yoğun bakım ünitesinde hayatı tehdit eden düşük kardiyak debi sendromunun patofizyolojisi, etiyolojisi, klinik tanımı ve tedavi seçeneklerini özetlemeyi amaçladık.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Parr GV, Blackstone EH, Kirklin JW. Cardiac performance and mortality early after intracardiac surgery in infants and young children. Circulation. 1975;51(5):867-874. [CrossRef]
2. Wessel DL. Managing low cardiac output syndrome after congenital heart surgery. Crit Care Med. 2001;29(10):S220-S230. [CrossRef]
3. 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(8):2226-2235. [CrossRef]
4. Ulate KP, Yanay O, Jeffries H, Baden H, Di Gennaro JL, Zimmerman J. An elevated low cardiac output syndrome score is associated with morbidity in infants after congenital heart surgery. Pediatr Crit Care Med. 2017;18(1):26-33. [CrossRef]
5. Sahulee R, McKinstry J. Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use. Vessel Plus. 2022;6:5. [CrossRef]
6. Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-cardiac-output syndrome after cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31(1):291-308. [CrossRef]
7. Ravishankar C, Tabbutt S, Wernovsky G. Critical care in cardiovascular medicine. Curr Opin Pediatr. 2003;15(5):443-453. [CrossRef]
8. 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(7):996-1002. [CrossRef]
9. Butts RJ, Scheurer MA, Atz AM, et al. 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(4):633-638. [CrossRef]
10. Aslan N, Yıldızdaş D, Göçen U, et al. Low cardiac output syndrome score to evaluate postoperative cardiac surgery patients in a pediatric intensive care unit. Turk Kardiyol Dern Ars. 2020;48(5):504- 513. [CrossRef]
11. Murni IK, Djer MM, Yanuarso PB, et al. Outcome of pediatric cardiac surgery and predictors of major complication in a developing country. Ann Pediatr Cardiol. 2019;12(1):38-44. [CrossRef]
12. Jones B, Hayden M, Fraser JF, Janes E. Low cardiac output syndrome in children. Curr Anaesth Crit Care. 2005;16(6):347-358. [CrossRef]
13. Bozdoğan ÖN. Açık Kalp Cerrahisi Sonrası Gelişen Düşük Kalp Debisi. JARSS. 2020;28(1):1-11.
14. Jozwiak M, Monnet X, Teboul JL. Monitoring: from cardiac output monitoring to echocardiography. Curr Opin Crit Care. 2015;21(5):395- 401. [CrossRef]
15. Gil-Anton J, Redondo S, Garcia Urabayen D, Nieto Faza M, Sanz I, Pilar J. Combined cerebral and renal near-infrared spectroscopy after congenital heart surgery. Pediatr Cardiol. 2015;36(6):1173-1178. [CrossRef]
16. Protsyk V, Rasmussen BS, Guarracino F, Erb J, Turton E, Ender J. Fluid management in cardiac surgery: results of a survey in European cardiac anesthesia depart- ments. J Cardiothorac Vasc Anesth. 2017;31(5):1624-1629. [CrossRef]
17. 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(2):234-238. [CrossRef]
18. Yuerek M, Rossano JW, Mascio CE, Shaddy RE. Postoperative management of heart failure in pediatric patients. Expert Rev Cardiovasc Ther. 2016;14(2):201-215. [CrossRef]
19. Pérez-Navero JL, de la Torre-Aguilar MJ, Ibarra de la Rosa I, et al. Cardiac biomarkers of low cardiac output syndrome in the postoperative period after congenital heart disease surgery in children. Rev Esp Cardiol (Engl Ed). 2017;70(4):267-274. [CrossRef]
20. Vincent JL, Quintairos E Silva A, Couto L, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20(1):257. [CrossRef]
21. Roeleveld PP, de Klerk JCA. The perspective of the intensivist on inotropes and postoperative care following pediatric heart surgery: an international survey and systematic review of the literature. World J Pediatr Congenit Heart Surg. 2018;9(1):10-21. [CrossRef]
22. 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(1):73-80. [CrossRef]
23. Shi S, Zhao Z, Liu X, et al. Perioperative risk factors for prolonged mechanical ventilation fol- lowing cardiac surgery in neonates and young infants. Chest. 2008;134(4):768-774. [CrossRef]
24. Loomba RS, Flores S. Use of vasoactive agents in postoperative pediatric cardiac patients: insights from a national database. Congenit Heart Dis. 2019;14(6):1176-1184. [CrossRef]
25. Jentzer JC, Hollenberg SM. Vasopressor and inotrope therapy in cardiac critical care. J Intensive Care Med. 2021;36(8):843-856. [CrossRef]
26. Marik PE. Dopamine increases mortality in pediatric septic shock. J Pediatr. 2016;168:253-256. [CrossRef]
27. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020;21(2):e52-e106. [CrossRef]
28. Rui Q, Jiang Y, Chen M, Zhang N, Yang H, Zhou Y. Dopamine versus norepinephrine in the treatment of cardiogenic shock: a PRISMAcompliant meta-analysis. Med (Baltim). 2017;96(43):e8402. [CrossRef]
29. Burkhardt BE, Rücker G, Stiller B. Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease. Cochrane Database Syst Rev. 2015;3(3):CD009515. [CrossRef]
30. Lewis TC, Aberle C, Altshuler D, Piper GL, Papadopoulos J. Comparative effectiveness and safety between milrinone or dobutamine as initial inotrope therapy in cardiogenic shock. J Cardiovasc Pharmacol Ther. 2019;24(2):130-138. [CrossRef]
31. Smith AH, Owen J, Borgman KY, Fish FA, Kannankeril PJ. Relation of milrinone after surgery for congenital heart disease to significant postoperative tachyarrhythmias. Am J Cardiol. 2011;108(11):1620- 1624. [CrossRef]
32. Lechner E, Hofer A, Leitner-Peneder G, et al. Levosimendan versus milrinone in neonates and infants after corrective open-heart surgery: a pilot study. Pediatr Crit Care Med. 2012;13(5):542-548. [CrossRef]
33. Momeni M, Rubay J, Matta A, et al. Levosimendan in congenital cardiac surgery: a randomized, double-blind clinical trial. J Cardiothorac Vasc Anesth. 2011;25(3):419-424. [CrossRef]
34. Appelbaum A, Blackstone EH, Kouchoukos NT, Kirklin JW. Afterload reduction and cardiac ouptut in infants early after intracardiac surgery. Am J Cardiol. 1977;39(3):445-451. [CrossRef]
35. Stone ML, Kelly J, Mistry M, Buck M, Gangemi J, Vergales J. Use of nicardipine after cardiac operations is safe in children regardless of age. Ann Thorac Surg. 2018;105(1):181-185. [CrossRef]
36. Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K. Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA. 2005;293(15):1900-1905. [CrossRef]
37. Miller OI, Tang SF, Keech A, Pigott NB, Beller E, Celermajer DS. Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: a randomised double-blind study. Lancet. 2000;356(9240):1464-1469. [CrossRef]
38. Wong J, Loomba RS, Evey L, Bronicki RA, Flores S. Postoperative inhaled nitric oxide does not decrease length of stay in pediatric cardiac surgery admissions. Pediatr Cardiol. 2019;40(8):1559-1568. [CrossRef]
39. Graham EM, Atz AM, Butts RJ, et al. Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: results from a randomized trial. J Thorac Cardiovasc Surg. 2011;142(6):1523-1529. [CrossRef]
40. Li Y, Luo Q, Wu X, Jia Y, Yan F. Perioperative corticosteroid therapy in children undergoing cardiac surgery: a systematic review and meta-analysis. Front Pediatr. 2020;8:350. [CrossRef]
41. Flores S, FitzGerald MR, Iliopoulos I, et al. An international survey of corticosteroid use for the management of low cardiac output syndrome. Pediatr Crit Care Med. 2017;18(7):630-637. [CrossRef]
42. Robert SM, Borasino S, Dabal RJ, Cleveland DC, Hock KM, Alten JA. Postoperative hydrocortisone infusion reduces the prevalence of low cardiac output syndrome after neonatal cardiopulmonary bypass. Pediatr Crit Care Med. 2015;16(7):629-636. [CrossRef]
43. Marwali EM, Caesa P, Darmaputri S , et al. Oral triiodothyronine supplementation decreases low cardiac output syndrome after pediatric cardiac surgery. Pediatr Cardiol. 2019;40(6):1238-1246. [CrossRef]
44. Flores S, Loomba RS, Checchia PA, Graham EM, Bronicki RA. Thyroid hormone (triiodothyronine) therapy in children after congenital heart surgery: a meta-analysis. Semin Thorac Cardiovasc Surg. 2020;32(1):87-95. [CrossRef]
45. McIntyre WF, Um KJ, Alhazzani W, et al. Association of vasopressin plus catecholamine vasopressors vs catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA. 2018;319(18):1889-1900. [CrossRef]
46. Maas JJ, Pinsky MR, de Wilde RB, de Jonge E, Jansen JR. Cardiac output response to norepinephrine in postoperative cardiac surgery patients: interpretation with venous return and cardiac function curves. Crit Care Med. 2013;41(1):143-150. [CrossRef]
47. McCammond AN, Axelrod DM, Bailly DK, Ramsey EZ, Costello JM. Pediatric cardiac Intensive Care Society 2014 consensus statement: pharmacotherapies in cardiac critical care fluid management. Pediatr Crit Care Med. 2016;17(3):S35-S48. [CrossRef]
48. Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early initiation of renal replacement therapy in pediatric heart surgery is associated with lower mortality. Pediatr Cardiol. 2016;37(4):623-628. [CrossRef]
49. Faraoni D, Meier J, New HV, Van der Linden PJ, Hunt BJ. Patient blood management for neonates and children undergoing cardiac surgery: 2019 NATA Guidelines. J Cardiothorac Vasc Anesth. 2019;33(12):3249-3263. [CrossRef]
50. Brown LM, Kratz A, Verba S, et al. Pain and opioid use After thoracic surgery: where we are and where we need to go. Ann Thorac Surg. 2020;109(6):1638-1645. [CrossRef]
51. Jiang L, Ding S, Yan H, et al. A retrospective comparison of dexmedetomidine versus midazolam for pediatric patients with congenital heart disease requiring postoperative sedation. Pediatr Cardiol. 2015;36(5):993-999. [CrossRef]
52. Mascio CE, Austin EH, Jacobs JP, et al. Perioperative mechanical circulatory support in children: an analysis of the society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg. 2014;147(2):658-664. [CrossRef]

APA	Aslan N, yildizdas d (2022). Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. , 284 - 292. 10.5543/tkda.2022.21212
Chicago	Aslan Nagehan,yildizdas dincer Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. (2022): 284 - 292. 10.5543/tkda.2022.21212
MLA	Aslan Nagehan,yildizdas dincer Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. , 2022, ss.284 - 292. 10.5543/tkda.2022.21212
AMA	Aslan N,yildizdas d Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. . 2022; 284 - 292. 10.5543/tkda.2022.21212
Vancouver	Aslan N,yildizdas d Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. . 2022; 284 - 292. 10.5543/tkda.2022.21212
IEEE	Aslan N,yildizdas d "Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists." , ss.284 - 292, 2022. 10.5543/tkda.2022.21212
ISNAD	Aslan, Nagehan - yildizdas, dincer. "Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists". (2022), 284-292. https://doi.org/10.5543/tkda.2022.21212

APA	Aslan N, yildizdas d (2022). Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. Türk Kardiyoloji Derneği Arşivi, 50(4), 284 - 292. 10.5543/tkda.2022.21212
Chicago	Aslan Nagehan,yildizdas dincer Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. Türk Kardiyoloji Derneği Arşivi 50, no.4 (2022): 284 - 292. 10.5543/tkda.2022.21212
MLA	Aslan Nagehan,yildizdas dincer Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. Türk Kardiyoloji Derneği Arşivi, vol.50, no.4, 2022, ss.284 - 292. 10.5543/tkda.2022.21212
AMA	Aslan N,yildizdas d Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. Türk Kardiyoloji Derneği Arşivi. 2022; 50(4): 284 - 292. 10.5543/tkda.2022.21212
Vancouver	Aslan N,yildizdas d Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists. Türk Kardiyoloji Derneği Arşivi. 2022; 50(4): 284 - 292. 10.5543/tkda.2022.21212
IEEE	Aslan N,yildizdas d "Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists." Türk Kardiyoloji Derneği Arşivi, 50, ss.284 - 292, 2022. 10.5543/tkda.2022.21212
ISNAD	Aslan, Nagehan - yildizdas, dincer. "Low Cardiac Output Syndrome After Cardiac Surgery: A Life-Threatening Condition from the Perspective of Pediatric Intensivists". Türk Kardiyoloji Derneği Arşivi 50/4 (2022), 284-292. https://doi.org/10.5543/tkda.2022.21212