The Hemodynamic Effects of Bolus Dose Calcium in Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot Study

Abstract

Objectives: To determine if bolus administration of calcium increases pulmonary artery pressures after unifocalization procedures or pulmonary artery reconstruction surgery. Design: Retrospective cohort study using Stanford University's data warehouse. Setting: A large pediatric heart center within an academic quaternary care facility. Participants: All patients undergoing pulmonary artery reconstruction or unifocalization procedure identifiable within the data warehouse. Interventions: We collected data from Stanford University's data repository; we formatted it and analyzed it using RStudio (v 2023.06.1+524). Measurements and Main Results: Our primary outcome is the change in pulmonary artery systolic pressure (PASP) after a bolus administration of calcium. Secondary endpoints include changes in pulmonary arterial to systemic arterial pressure ratio, mean arterial pressure, right sided filling pressure, and left atrial pressure. We used the Friedman test to assess differences and the Durbin-Conover rank-sum for pairwise comparisons. We found a difference in PASP after a bolus dose of calcium (Friedman X2 = 13.67, p = 0.003), with a higher PASP five minutes after calcium administration when compared to two minutes before the administration (35 mmHg versus 33 mmHg, p = 0.01), and a higher PASP 10 minutes after calcium administration when compared to two minutes before the administration (35 mmHg versus 33 mmHg, p = 0.008). Conclusions: Calcium bolus administration led to an increase in pulmonary arterial pressure in patients after pulmonary artery reconstruction or unifocalization surgeries. It may be prudent to avoid bolus administration in this patient population immediately after repair or in patients with right ventricular dysfunction.