TY - JOUR
T1 - Predicted clinical factors associated with the intensive care unit length of stay after total cavopulmonary connection
AU - Ono, Masamichi
AU - Burri, Melchior
AU - Balling, Gunter
AU - Beran, Elisabeth
AU - Cleuziou, Julie
AU - Pabst von Ohain, Jelena
AU - Strbad, Martina
AU - Hager, Alfred
AU - Hörer, Jürgen
AU - Lange, Rüdiger
N1 - Publisher Copyright:
© 2018 The American Association for Thoracic Surgery
PY - 2019/5
Y1 - 2019/5
N2 - Objectives: A longer length of stay (LOS) in the intensive care unit (ICU) after the total cavopulmonary connection (TCPC) is thought to be a predictive sign of late Fontan failure. This study was performed to determine the clinical risk factors for ICU LOS. Methods: In total, 483 patients who underwent a TCPC between May 1994 and December 2016 were included the study. Patients’ main diagnosis, morphologic characteristics, palliative procedures, hemodynamic parameters, and perioperative variables, were analyzed to identify risk factors influencing ICU stay based on Cox regression. Causes of longer ICU LOS and the impact of ICU LOS on late outcomes were evaluated. Results: Age at TCPC, type of TCPC, and fenestration at TCPC did not affect the ICU LOS. With multivariable model, hypoplastic left heart syndrome (P =.001) and anomalous systemic venous drainage (P <.001) were identified as independent morphologic risk factors for prolonged ICU LOS. Of hemodynamic variables, preoperative high transpulmonary gradient (P =.037), and low aortic oxygen saturation (P =.031) were risks for longer ICU LOS. Of postoperative variables, pleural effusion (P <.001), chylothorax (P =.001), ascites (P <.001), and infection (P =.028) were risks for longer ICU LOS. The ICU LOS was found to be significantly associated with late mortality (P <.001) and late cardiac reoperation (P =.007). Conclusions: Patients with hypoplastic left heart syndrome and anomalous systemic venous drainage had longer ICU LOS. Extended cyanosis and elevated pulmonary artery pressure affect the ICU LOS. Special care should be provided during the initial postoperative phase in patients with such risk factors.
AB - Objectives: A longer length of stay (LOS) in the intensive care unit (ICU) after the total cavopulmonary connection (TCPC) is thought to be a predictive sign of late Fontan failure. This study was performed to determine the clinical risk factors for ICU LOS. Methods: In total, 483 patients who underwent a TCPC between May 1994 and December 2016 were included the study. Patients’ main diagnosis, morphologic characteristics, palliative procedures, hemodynamic parameters, and perioperative variables, were analyzed to identify risk factors influencing ICU stay based on Cox regression. Causes of longer ICU LOS and the impact of ICU LOS on late outcomes were evaluated. Results: Age at TCPC, type of TCPC, and fenestration at TCPC did not affect the ICU LOS. With multivariable model, hypoplastic left heart syndrome (P =.001) and anomalous systemic venous drainage (P <.001) were identified as independent morphologic risk factors for prolonged ICU LOS. Of hemodynamic variables, preoperative high transpulmonary gradient (P =.037), and low aortic oxygen saturation (P =.031) were risks for longer ICU LOS. Of postoperative variables, pleural effusion (P <.001), chylothorax (P =.001), ascites (P <.001), and infection (P =.028) were risks for longer ICU LOS. The ICU LOS was found to be significantly associated with late mortality (P <.001) and late cardiac reoperation (P =.007). Conclusions: Patients with hypoplastic left heart syndrome and anomalous systemic venous drainage had longer ICU LOS. Extended cyanosis and elevated pulmonary artery pressure affect the ICU LOS. Special care should be provided during the initial postoperative phase in patients with such risk factors.
KW - anomalous systemic venous drainage
KW - hypoplastic left heart syndrome
KW - intensive care unit
KW - pleural effusion
KW - total cavopulmonary connection
UR - http://www.scopus.com/inward/record.url?scp=85058511283&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2018.10.144
DO - 10.1016/j.jtcvs.2018.10.144
M3 - Article
C2 - 30578061
AN - SCOPUS:85058511283
SN - 0022-5223
VL - 157
SP - 2005-2013.e3
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -