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

Abstract

Ventricular-arterial coupling is the ratio of arterial elastance to ventricular end-systolic elastance. 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. 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. 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±7.5mmHg/cm2 /m2 , p<.001) compared with the ventricular end-systolic elastance index (from 13.0±6.9 to 16.9±9.0mmHg/cm2 /m2 , 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 (>15h; OR: 11.00; 95% CI: 1.26-96.45, p=.030), and longer postoperative hospital stay (>7days; OR: 2.98; 95% CI: 1.04-8.58, p=.043). 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.