Abstract 6961: Anesthetic Management During Pre-Stage II Intracardiac Hemodynamic Assessment: An Analysis of the Single Ventricle Reconstruction Trial Dataset

Abstract

Background: Intracardiac hemodynamics are often obtained with cardiac catheterization prior to proceeding with Stage II palliation for infants with single ventricle anatomy. There is little data examining the hemodynamic impact of anesthetic strategy during catheterization. Methods: Data from the Pediatric Heart Network Single Ventricle Reconstruction Trial was used for analysis. In addition to anesthetic strategy, data reported from cardiac catheterization prior to Stage II palliation included mean systemic venous atrial pressure (MSVAP), end diastolic ventricular pressure (EDVP), pulmonary flow (Q p )/systemic flow (Q s ) ratio, and indexed pulmonary vascular resistance (PVRi). Indexed systemic vascular resistance (SVRi), Q p , and Q s were calculated using available hemodynamic data. Results: Of 549 subjects, pre-Stage II cardiac catheterization data following palliation with a modified Blalock-Taussig-Thomas shunt (mBTTS) or right ventricle to pulmonary artery conduit (RV2PA) was available for 390, of which 219 had adequate hemodynamic data for inclusion in analysis. Intracardiac hemodynamic comparisons were made with respect to anesthetic approach and shunt type. Moderate sedation was utilized in 90 (41%) and general anesthesia in the remaining 129 subjects. A moderate sedation strategy was associated with significantly higher Q p /Q s (1.2 [0.9, 1.6] v. 1.0 [0.7, 1.3], p<0.001) and estimated SVRi (15 Wu•m 2 [11,19] v. 10 [7.8,15], p<0.001), a difference consistent among both mBTTS and RV2PA subgroups. There were no differences between anesthetic groups with respect to PVRi or calculated Q s in either shunt group. Independent of shunt type, PVRi, and patient weight at catheterization, moderate sedation at catheterization was associated with a two-fold odds of a reported Q p /Q s >1 (OR 2.03, 95%CI 1.13-3.63, p=0.017). Conclusions: Anesthetic strategy and alterations in SVRi represent an important consideration when evaluating hemodynamics in a shunt dependent single ventricle circulation. Future investigations may aid in understanding the relationship between anesthetic approach during catheterization and the resulting hemodynamic data employed in perioperative decision-making.