Severe Low Cardiac Output Research Articles

Comparative Analysis of Therapeutic Strategies in Post-Cardiotomy Cardiogenic Shock: Insight into a High-Volume Cardiac Surgery Center.

Background: Post-cardiotomy cardiogenic shock (PCCS), which is defined as severe low cardiac output syndrome after cardiac surgery, has a mortality rate of up to 90%. No study has yet been performed to compare patients with PCCS treated by conservative means to patients receiving additional mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMO). Methods: A single-center retrospective analysis from January 2018 to June 2022 was performed. Results: Out of 7028 patients who underwent cardiac surgery during this time period, 220 patients (3%) developed PCCS. The patients were stratified according to their severity of shock based on the Stage Classification Expert Consensus (SCAI) group. Known risk factors for shock-related mortality, including the vasoactive-inotropic score (VIS) and plasma lactate levels, were assessed at structured intervals. In patients treated additionally with ECMO (n = 73), the in-hospital mortality rate was 60%, compared to an in-hospital mortality rate of 85% in patients treated by conservative means (non-ECMO; n = 52). In 18/73 (25%) ECMO patients, the plasma lactate level normalized within 48 h, compared to 2/52 (4%) in non-ECMO patients. The morbidity of non-ECMO patients compared to ECMO patients included a need for dialysis (42% vs. 60%), myocardial infarction (19% vs. 27%), and cerebrovascular accident (17% vs. 12%). Conclusions: In conclusion, the additional use of ECMO in PCCS holds promise for enhancing outcomes in these critically ill patients, more rapid improvement of end-organ perfusion, and the normalization of plasma lactate levels.

Successful treatment of cardiogenic shock due to Takotsubo syndrome with implantation of a temporary microaxial left ventricular assist device in transaxillary approach

ObjectivesCardiogenic shock (CS) can occur in patients with Takotsubo syndrome (TTS). As TTS has received increasing attention and has been more closely researched, several aspects of the pathogenesis have been identified, particularly that an excessive release of catecholamines plays an important role. Nevertheless, evidence on specific therapy concepts is still lacking. As a result, TTS with severe hemodynamic instability and low cardiac output creates unique challenges, and mechanical circulatory support is needed with as few inotropic drugs as possible.MethodsWe present a 77-year-old female patient who underwent minimally invasive surgical mitral valve replacement. After an uneventful course, the patient developed acute heart failure eleven days after surgery. Transthoracic echocardiography (TTE) revealed a new onset of TTS. The patient needed left ventricular venting and full haemodynamic flow. We successfully implanted a microaxial left ventricular assist device (Impella 5.5) using the transaxillary approach. The haemodynamic situation stabilised immediately. The patient was weaned and the Impella 5.5 was explanted after five days.ConclusionWe present the first-in-man implantation of a transaxillary Impella 5.5 in a patient with TTS. The patient benefitted from Impella 5.5 therapy with full haemodynamic support and venting of the left ventricle.

Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function.

Extracorporeal Membrane Oxygenation (ECMO) is used as a bridge to recovery of cardiac function following completion of congenital cardiac surgeries where there is failure to wean from cardiopulmonary bypass (CPB) or severe low cardiac output states in the post operative periods. Although ECMO is a well-established form of mechanical circulatory support, the associated cost can be a huge financial burden on families. We are an ECMO center and use the same in post operative congenital cardiac surgeries for mechanical cardiovascular support if needed. However, a significant proportion of the children, whom we operate, are funded by government aides. The resources are limited in such circumstances. If needed, we use the same CPB circuit and cannulae used in the Operating Room (OR) and support them at a significantly lower cost compared to ECMO. We report our experience of using conventional CPB machine as a short-term bridge to recovery of cardiac function in Intensive Care Unit where there was limitation of funds. Essentially same CPB circuit with roller pump is retained, by omitting cardiotomy suckers. We use D901 Lilliput 1 Oxygenator (Sorin, Italy) for children <5kg and D902 Lilliput 2 (Sorin, Italy) Oxygenator for children >5Kg. We supported nine patients on CPB between March 2019 and December 2021. During this time, 1392 congenital cardiac surgeries were performed. We could wean off three patients (33.3%) and discharge two patients (22.2%). Our support time ranged from 21h to 60h with a median of 48h. Beyond 48h of support, we experienced several CPB induced complications in our cohort. In resource-limited settings, conventional CPB machines can be used for short-term cardiac support. Although results may not be comparable to using ECMO, some patients can be definitely salvaged, who would otherwise die in the absence of institution of mechanical circulatory support.

Risk factors of postoperative atrial fibrillation in patients undergoing beating heart coronary artery bypass

Aim: This study aims to establish new-onset atrial fibrillation (AF) risk factors and postoperative outcomes after off-pump coronary artery bypass graft (CABG) surgery. Material and Methods: Four hundred ninety patients who underwent off-pump CABG were enclosed in study. Patients divided into two groups in line with the development of new-onset AF as AF group (n=62) and non-AF group (n=428). Groups were compared in terms of preoperative clinical features and perioperative data, and multivariate analysis accomplished to identify independent clinical predictors of AF following off-pump CABG. Results: AF was presented in 62 (12.7%) of the patients, and those were significantly older and had significantly higher additive EuroSCORE scores than without AF. Also patients with postoperative AF had significantly prolonged intensive care unit and longer hospital stays at postoperative period. In the multivariant logistic regression analysis performed, advanced age, mean Euroscore, Mild to moderate mitral regurgitation, Prolonged air leak from thorax drain, mean ventilation time, severe pleural effusion, need for inotropic drug support were found to be risk factors for postoperative AF. Conclusion: Our study showed that age, high Euroscore, mild to moderate mitral regurgitation, prolonged ventilation time, severe pleural effusion and low cardiac output were risk factors of postoperative AF in patients underwent off-pump CABG. Also In patients who developed postoperative AF, prolonged intensive care unit and hospital stays were observed. Prospective randomized studies with larger patient series are recommended to support our study.

A case report of thrombotic complete obstruction of the ascending aorta as a complication of Venoarterial extracorporeal membrane oxygenation support: steps to prevent thrombosis

BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential device in the field of emergency and intensive-care medicine. However, long-term use of VA-ECMO has various severe complications, including thrombosis.Case presentationA 60-year-old man underwent his third aortic root replacement using a homograft because of infectious endocarditis. Although the operation was difficult because of severe adhesion caused by the two previous interventions, aortic root replacement using a homograft was performed. At the time of withdrawal from cardiopulmonary bypass, the maintenance of hemodynamics was difficult because of bleeding from the surgical site, leading to hypovolemic shock. Cardiac function subsequently deteriorated; therefore, VA-ECMO was established and the operation was finished. Three days later, thrombus was formed inside the homograft and completely occluded ascending aorta. Evacuation of hematoma was performed, however, cardiac function was not ameliorated. Eventually, the patient had brain infarction and died. To prevent thrombus formation in very severe low cardiac output cases under VA-ECMO management after surgery, to prevent the stagnation of the blood flow from VA-ECMO will be necessary because anticoagulant therapy will be difficult. Impella ventricular assist device which is recently used widely generates anterograde blood flow and effectively prevents stagnation.ConclusionsTo prevent thrombus formation in cases of very severe low cardiac output, Impella® should be combinatorially introduced from the beginning of VA-ECMO establishment to prevent thrombosis.

Fluid Overload in Special Pediatric Cohorts With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery Following Surgical Repair

To investigate the prevalence, risk factors, and clinical outcomes associated with early fluid overload (FO) in a special group of pediatric patients undergoing repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). It was a retrospective study performed with multiple variable regression analysis. A single cardiac surgical institution. Eighty-eight patients younger than 18 years of age undergoing ALCAPA surgical repair with cardiopulmonary bypass were recruited at the authors' institution from June 2010 to September 2017. None. Of 88 pediatric patients with ALCAPA after surgical repair, 37.5% developed early FO, defined as fluid accumulation ≥5% within the period from surgery until midnight of postoperative day 1. Patients with early FO were younger, weighed less, and had worse preoperative cardiac dysfunction. With logistic regression analysis, being underweight was confirmed to be a risk factor for FO development (odds ratio, 8.66; 95% confidence interval, 2.83-26.52; p < 0.001). Early FO also predicted severe acute kidney injury, respiratory morbidity, and low cardiac output syndrome after reimplantation procedure. Patients with early FO also had significantly longer mechanical ventilation hours (p < 0.001), intensive care unit length of stay (p = 0.003), and hospital length of stay (p = 0.009). Early FO ≥5% has been linked to adverse postoperative outcomes in pediatric patients undergoing repair for ALCAPA. The use of restrictive fluid management is crucial for patients who have lower weight and poor myocardial function before and after complex surgical procedures such as in ALCAPA settings.

Escorpionism in pediatric intensive care patients. Case series

Scorpionism is a public health problem with an increasing incidence in Argentina. The poison contains several neurotoxins capable of generating an "autonomic storm" responsible for the clinical manifestations. The cardiovascular and respiratory systems are the most affected ones and their degree of commitment will determine morbidity and mortality. A 10 % of cases in children evolve to their severe form. In this retrospective series, we describe the epidemiology and evolution of 17 patients admitted to the Pediatric Intensive Care Unit from January 2010 to January 2014. Although there was no mortality, there was a high morbidity: 12 patients had acute lung edema requiring mechanical ventilation, 11 patients developed hypotensive cardiogenic shock, 7 were under severe low cardiac output and in 6 levosimendan was used due to the low refractory output.

Outcomes of Infant Cardiac Surgery for Congenital Heart Disease Concomitant With Persistent Pneumonia: A Retrospective Cohort Study

There is still controversy about whether an infant should have cardiac surgery concomitant with ongoing persistent pneumonia. This study analyzes the outcome of surgical treatment for infants with left-to-right shunt congenital heart disease accompanied with persistent pneumonia and discusses the perioperative management strategies for these cases. This is a retrospective cohort study. This study was conducted in an academic hospital and is a single-center study. In this study, the authors analyzed the data of 94 infants admitted to our hospital from January 2014 to May 2016 who underwent surgical correction for left-to-right shunt congenital heart disease. Fifty cases without pneumonia were included as a control group, and 44 cases with unresolved persistent pneumonia were included as a study group. The clinical characteristics between the 2 groups were compared, and the perioperative safety and short-term prognosis were evaluated. There was no significant difference in sex composition between the 2 groups. Infants in the pneumonia group were younger and had a lower body weight (p < 0.001). There was a significant difference in types of congenital heart disease between the 2 groups (p < 0.001). Preoperative body temperature and heart rate of infants in the pneumonia group were higher than those in the control group (p < 0.001). The cardiopulmonary bypass time in the pneumonia group was significantly longer than that of the control group (p = 0.001). Perioperative major complications were not significantly different between the 2 groups. The postoperative ventilator-assisted time, duration of intensive care unit stay, and length of hospital stay were longer in the pneumonia group (p < 0.001). Only 1 patient in the control group died of severe low cardiac output syndrome. The authors conclude that in the presented cases, no mortality or major morbidity was observed related to the practice of performing surgery in infants with signs of persistent pneumonia. The authors conclude that it is likely to be safe and effective for infants to receive cardiac surgery for left-to-right shunt congenital heart disease in the presence of persistent pneumonia.

Perioperative management of critical right ventricular inflow obstruction from right atrial rhabdomyoma

Rhabdomyoma is the most common cardiac tumor in infancy and commonly located in the ventricles causing outflow obstruction or arrhythmias. We report a rare pediatric (7 month old) case of a right atrial rhabdomyoma presenting with severe cyanosis and low cardiac output from significant tricuspid inflow obstruction with right to left shunt across a stretched patent foramen ovale. We present an emergency cardiac surgery for right atrial tumor resection, and the management of separating the patient with failing right ventricle from cardiopulmonary bypass using a Glenn shunt, since extracorporeal membrane oxygenation (ECMO) or nitric oxide was not available.

Prenatal Maternal Hyperoxygenation Testing and Implications for Critical Care Delivery Planning among Fetuses with Congenital Heart Disease: Early Experience.

Maternal hyperoxygenation (MH) during fetal ultrasound can characterize fetal pulmonary vasoreactivity (PVr) and its associations with postnatal physiology. We explored MH testing to facilitate perinatal risk stratification for fetuses with congenital heart disease (CHD). MH was performed in 12 fetuses: 2 with Ebstein anomaly, 2 with total anomalous pulmonary venous connection (TAPVC), 4 with hypoplastic left heart syndrome (HLHS) with (a) restrictive atrial septum (RAS) or (b) intact atrial septum (IAS) with decompressing vertical vein (VV), and 4 with D-loop transposition of the great arteries (TGA). PVr and physiologic and anatomic changes with MH and outcomes were recorded. Among Ebstein fetuses, pulmonary blood flow with MH mirrored postnatal findings. Among TAPVC fetuses, MH VV gradients correlated with postnatal gradients. One HLHS/IAS/VV fetus had no PVr and decreased pulmonary vein forward to reverse velocity time integral ratio with MH. Shortly after delivery, the infant experienced severe low cardiac output and required urgent atrial septoplasty. The remaining HLHS fetuses had PVr and underwent routine Stage 1 Norwood. Among TGA fetuses, septum primum position, foramen ovale flow, and the presence or absence of PVr with MH reflected postnatal findings. MH may help identify fetuses with CHD at risk for perinatal compromise. Additional study may yield insights into fetal PVr and elucidate predictors of perinatal outcomes.

An International Survey of Corticosteroid Use for the Management of Low Cardiac Output Syndrome.

Limited evidence exists on use of corticosteroids in low cardiac output syndrome following cardiac surgery. We sought to determine physicians' practices and beliefs with regard to corticosteroids therapy for low cardiac output syndrome. Multinational internet-based survey. Pediatric Cardiac Intensive Care Society member database. Pediatric cardiac intensive care physicians. None. We received 188 responses from 85 centers throughout the world including 57 U.S. congenital heart centers, eight Canadian centers, and 20 international centers. The majority of respondents (51%) reported performing at least 200 bypass cases per year and had separate dedicated cardiac ICUs (57%). Most physicians (89%) rarely or never prescribe corticosteroids for mild low cardiac output syndrome (single vasoactive agent and mildly decreased perfusion), whereas 94% of those surveyed sometimes or always administer corticosteroids to patients with severe low cardiac output syndrome (two or more vasoactive agents and persistent hypotension). Hydrocortisone was the most commonly used corticosteroids (88%), but there was no consensus on dosage used. There was a variable approach to cortisol level measurement and cortisol stimulation testing to inform therapy with corticosteroids. A majority of respondents (75%) stated that they would be willing to randomize patients with severe low cardiac output syndrome into a trial of corticosteroids efficacy. Our survey demonstrates considerable practice variability with regard to the type of patients in whom corticosteroids are administered, adrenal axis testing is performed, and dosage of hydrocortisone used. The majority of physicians, however, stated their willingness to randomize patients with severe low cardiac output syndrome in a corticosteroids trial. This survey identified multiple areas for future research on use of corticosteroids for low cardiac output syndrome.

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis.

OBJECTIVESTo investigate the in-hospital health outcome and 10-year survival in patients undergoing redo coronary surgery with (redo-CABG) or without (redo-OPCAB) cardiopulmonary bypass.METHODSA total of 349 redo coronary surgery patients were identified from our registry. Of these, 143 redo-OPCAB patients (40.97%) were compared with 206 redo-CABG patients. To minimize the bias, we also conducted propensity score matching. In Matched Analysis A, 111 redo-OPCAB patients with any type of primary cardiac operation were compared with 111 redo-CABG cases. In Matched Analysis B, 84 redo-OPCAB patients with isolated coronary surgery as their primary operation were compared with 84 redo-CABG patients. We assessed for all 3 analyses a composite of in-hospital mortality, acute kidney injury, stroke and severe low cardiac output requiring intra-aortic balloon pump. In addition, we assessed 1-, 5-, and 10-year survival.RESULTSIn the unmatched analysis, redo-CABG was associated with higher usage of intra-aortic balloon pump (10 vs 3%, P = 0.01) and composite compared with redo-OPCAB (25 vs 16%, P = 0.06) and similar 10-year survival (67.2 vs 68.5%, log-rank test: P = 0.78). Matched Analysis A showed similar rates of composite (15 vs 21%, P = 0.25) and 10-year survival (65.1 vs 60.8%, log-rank test: P = 0.5). Matched Analysis B showed reduction of the composite (19 vs 8%, P = 0.04), less in-hospital mortality (5 vs 0%, P = 0.13), 4.5 times less need for intra-aortic balloon pump (2 vs 11%, P = 0.02) favouring redo-OPCAB and a similar 10-year survival (71.6 vs 71.7%, log-rank test: P = 0.61).CONCLUSIONSRedo-OPCAB surgery is feasible, safe and effective with improved in-hospital outcome and similar 10-year survival compared to redo-CABG.

Pulmonary hypertension in the intensive care unit. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

Acute pulmonary hypertension (PH) complicates the course of several cardiovascular, pulmonary and other systemic diseases in children. An acute rise of RV afterload, either as exacerbating chronic PH of different...

Post-operative complications and measures on complex cyanotic congenital heart diseases and pulmonary shunt

Objective To analyze the causes and treatment methods of early complications after central systemic-pulmonary shunt in complex cyanotic congenital heart diseases. Methods Two hundred and twelve cases of central systemic-pulmonary shunt in complex cyanotic congenital heart diseases were retrospectively analyzed in order to explore the early postoperative complications and related treatment measures. Results There were 61 cases(28.77%) of the early postoperative complications, including severe low cardiac output syndrome in 27 cases, acute pulmonary edema in 14 cases, 24 h shunt pipe blockage in 12 cases, and supraventricular tachycardia in 8 cases.All patients got followed up, average for(2.49±1.21) years.After the systemic-to-pulmonary artery shunts, pulmonary vascular had significant growth, 8 patients(3.77%) of them who pulmonary hypoplasia were promoted by transcatheter aortopulmonary collateral vessels.At the end of the follow-up, 77 patients(36.32%)achieved the standard of radical surgery. Conclusion The factors affecting surgical survival rate include: enhancement of patients cardiac function and strictly handle operation indication before operation a clear operational view; rational surgical methods; treatment of complication without delay; strict, intensive care and synthesized treatment. Key words: Systemic-pulmonary shunt; Cardiac surgery; Complication; Congenital heart disease,

Omentoplasty in deep sternal wound infection.

The aim of this study was to evaluate retrospectively the results of reconstructing infected post-sternotomy incisions with pedicled omentoplasty. Between March 2009 and December 2012, 15 females (37.5%) and 25 males (62.5%) with an average age of 63 y (range 51-72 y) who were suffering from deep sternal wound infection (DSWI) after coronary artery bypass grafting underwent reconstructive surgery. We evaluated their pre-operative characteristics and post-operative courses. Thirty-four of the patients (85%) were found to have DSWI within 1 mo of their cardiac surgery. The mean operative time for the omental flap (OF) procedure was 90±16.8 min (range 70-135 min). There were three intra-operative complications (7.5%), and post-operative complications occurred in 10 patients (25%). No patient developed any sign of OF necrosis. The median lengths of the post-operative intensive care unit (ICU) and hospital stays were 4 d (range 1-6 d) and 7 d (range 5-14 d), respectively. At the time of discharge, all patients had normal cardiac and mental status. We obtained satisfactory outcomes when treating the patients with DSWI by a single-stage OF transposition. On the basis of our experience, we recommend this procedure as an option for patients with DSWI, especially those who are not in a severe low cardiac output state or malnourished.

Short-term add-on therapy with angiotensin receptor blocker for end-stage inotrope-dependent heart failure patients: B-type natriuretic peptide reduction in a randomized clinical trial

OBJECTIVE:We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure.METHODS:We selected patients with decompensated heart failure, low cardiac output, dobutamine dependence, and an ejection fraction <0.45 who were receiving an angiotensin-converting enzyme inhibitor. The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention. ClinicalTrials.gov: NCT01857999.RESULTS:We studied 10 patients in the losartan group and 11 patients in the placebo group. The patient characteristics were as follows: age 52.7 years, ejection fraction 21.3%, dobutamine infusion 8.5 mcg/kg.min, indexed systemic vascular resistance 1918.0 dynes.sec/cm5.m2, cardiac index 2.8 L/min.m2, and B-type natriuretic peptide 1,403 pg/mL. After 7 days of intervention, there was a 37.4% reduction in the B-type natriuretic peptide levels in the losartan group compared with an 11.9% increase in the placebo group (mean difference, -49.1%; 95% confidence interval: -88.1 to -9.8%, p = 0.018). No significant difference was observed in the hemodynamic measurements.CONCLUSION:Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence.

English

Objective: To investigate whether the different concentrations of morphine after coronary perfusion have myocardial protection. Subjects and method: Forty-five patients undergoing heart valve replacement were randomly divided into three groups of 15 patients: group A (morphine 2 µmol/L in the cardioplegic solution), group B (morphine 4 µmol/L in the cardioplegic solution) and group C (no morphine in the cardioplegic solution). The three groups were monitored before induction (T1), five minutes before (T2) and five minutes after (T3) cardiopulmonary bypass (CPB), perioperative (T4) for haemodynamic parameters, two hours after CPB (T5) and 24 hours after CPB (T6). The postoperation incidence of severe ventricular arrhythmia and low cardiac output, CPB transit time, aortic cross-clamp time, defibrillation time, duration of ventilation and intensive care unit (ICU) and hospital stay were recorded. Results:The levels of cardiac troponin I (cTnI) at T5 and T6 in group A and group B were significantly lower than those in group C (p < 0.05), and at T6 in group B, were lower than those in group A (p < 0.05). The levels of CK-MB at T6 in group B were lower than those in group C (p < 0.05). The morphological changes in group A and group B were less than those in group C; and the least in group B. Conclusion:Morphine at concentrations of 2 µmol/L and 4 µmol/L after coronary perfusion on cardiac valve replacement with CPB has myocardial protection; 4 µmol/L of morphine provides more myocardial protection.

Cooling after successful resuscitation in cardiac surgery patients

BackgroundDespite many years of intensive research sudden cardiac death is one of the most common causes of death all over the world. The European Resuscitation Council (ERC) recommends the use of moderate therapeutic hypothermia for 12–24 hours to improve neurological outcome. However, the beneficial effect of this therapy on outcomes for cardiac surgery patients with In- Hospital- Resuscitation (IHR) has not been well studied.The purpose of this single center analysis was to investigate our first experience in a non – selected IHR population, where hypothermia was induced independent from initial heart rhythm disturbance.MethodA total of 20 resuscitated patients who were treated in our institution between January 2010 and December 2011 formed the study cohort.ResultsIn all patients post- resuscitation course was significantly prolonged with severe low cardiac output syndrome in six patients (30%). Overall four patients (20%) sustained septicemia with the need for high dose inotropic support. The 30 day mortality was 30% (six of twenty). However, stroke with severe neurological impairment appeared in only four patients (20%) after resuscitation with subsequent therapeutic hypothermia.ConclusionWith our observation study we could demonstrate the benefits for neurological outcome due to therapeutic hypothermia in cardiac surgery patients after successful resuscitation. However post- resuscitation treatment should focus on sufficient therapeutic strategies to avoid the distinctive short term morbidity and mortality.

Comparative analysis of early and middle outcomes of the arterial switch operation in children with complete transposition of the great arteries with ventricular septal defect and severe pulmonary artery hypertension

Background The best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old. Methods We studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were &lt;1 year old, 13 were 1-3 years old, and 13 were &gt;3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass. Results Three operative deaths occurred. Two were in the &lt;1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6-20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension. Conclusion Children older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.

Abstracts from the 3rd Annual Therapeutic Hypothermia and Temperature Management ConferenceMarch 4–5, 2013Miami, FL

Abstracts from the 3rd Annual Therapeutic Hypothermia and Temperature Management ConferenceMarch 4–5, 2013Miami, FL