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Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass.
Eur J Cardiothorac Surg. 2018 11 01; 54(5):953-958.EJ

Abstract

OBJECTIVES

Strict patient selection, short cardiopulmonary bypass (CPB) time and short mechanical ventilation are well-recognized aspects of optimizing the postoperative course after total cavopulmonary connection. In this study, we evaluated the influence of our early postoperative extubation strategy in our population of Fontan patients over the past 2 decades.

METHODS

Early postoperative course was evaluated retrospectively in 211 consecutive patients, who were selected for total cavopulmonary connection in our institution between 1995 and 2015. We analysed postoperative haemodynamic parameters and early outcome after surgery (mortality and length of hospital stay) according to preoperative patient characteristics, duration of CPB and duration of mechanical ventilation. To investigate the influence of mechanical ventilation, the cohort was subdivided into a 'fast-track' extubation group (≤6 h ventilation, n = 59) and a prolonged ventilation group (>6 h ventilation, n = 152).

RESULTS

In the entire cohort, duration of CPB did not correlate with duration of mechanical ventilation (P = 0.1), and it did not differ between both groups (P = 0.3). Patients in the fast-track group showed significantly better haemodynamics with higher mean arterial pressure and lower mean pulmonary artery pressure at 6, 24 and 48 h postoperatively when compared with the prolonged ventilation group (P = 0.02-0.001). In multivariable analysis, longer mechanical ventilation, but not duration of CPB, was independently associated with length of hospital stay.

CONCLUSIONS

Early weaning from mechanical ventilation correlates with improved early Fontan haemodynamics, whereas early outcome is unrelated to duration of CPB. This indicates that early extubation may represent a principal strategy for improving early results after total cavopulmonary connection.

Authors+Show Affiliations

Department of Congenital Heart Disease/Paediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.Department of Congenital Heart Disease/Paediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.Department of Congenital Heart Disease/Paediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.Department of Surgery for Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.Department of Anaesthesiology, German Heart Centre Berlin, Berlin, Germany.Department of Congenital Heart Disease/Paediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.Department of Surgery for Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.Department of Congenital Heart Disease/Paediatric Cardiology, German Heart Centre Berlin, Berlin, Germany. German Centre for Cardiovascular Research (DZHK), Congenital Heart Diseases, Partner Site Berlin, Berlin, Germany. Department of Paediatric Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29718154

Citation

Ovroutski, Stanislav, et al. "Early Extubation Is Associated With Improved Early Outcome After Extracardiac Total Cavopulmonary Connection Independently of Duration of Cardiopulmonary Bypass." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 54, no. 5, 2018, pp. 953-958.
Ovroutski S, Kramer P, Nordmeyer S, et al. Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass. Eur J Cardiothorac Surg. 2018;54(5):953-958.
Ovroutski, S., Kramer, P., Nordmeyer, S., Cho, M. Y., Redlin, M., Miera, O., Photiadis, J., & Berger, F. (2018). Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 54(5), 953-958. https://doi.org/10.1093/ejcts/ezy179
Ovroutski S, et al. Early Extubation Is Associated With Improved Early Outcome After Extracardiac Total Cavopulmonary Connection Independently of Duration of Cardiopulmonary Bypass. Eur J Cardiothorac Surg. 2018 11 1;54(5):953-958. PubMed PMID: 29718154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early extubation is associated with improved early outcome after extracardiac total cavopulmonary connection independently of duration of cardiopulmonary bypass. AU - Ovroutski,Stanislav, AU - Kramer,Peter, AU - Nordmeyer,Sarah, AU - Cho,Mi-Young, AU - Redlin,Matthias, AU - Miera,Oliver, AU - Photiadis,Joachim, AU - Berger,Felix, PY - 2018/01/03/received PY - 2018/04/02/accepted PY - 2018/5/3/pubmed PY - 2019/6/19/medline PY - 2018/5/3/entrez SP - 953 EP - 958 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 54 IS - 5 N2 - OBJECTIVES: Strict patient selection, short cardiopulmonary bypass (CPB) time and short mechanical ventilation are well-recognized aspects of optimizing the postoperative course after total cavopulmonary connection. In this study, we evaluated the influence of our early postoperative extubation strategy in our population of Fontan patients over the past 2 decades. METHODS: Early postoperative course was evaluated retrospectively in 211 consecutive patients, who were selected for total cavopulmonary connection in our institution between 1995 and 2015. We analysed postoperative haemodynamic parameters and early outcome after surgery (mortality and length of hospital stay) according to preoperative patient characteristics, duration of CPB and duration of mechanical ventilation. To investigate the influence of mechanical ventilation, the cohort was subdivided into a 'fast-track' extubation group (≤6 h ventilation, n = 59) and a prolonged ventilation group (>6 h ventilation, n = 152). RESULTS: In the entire cohort, duration of CPB did not correlate with duration of mechanical ventilation (P = 0.1), and it did not differ between both groups (P = 0.3). Patients in the fast-track group showed significantly better haemodynamics with higher mean arterial pressure and lower mean pulmonary artery pressure at 6, 24 and 48 h postoperatively when compared with the prolonged ventilation group (P = 0.02-0.001). In multivariable analysis, longer mechanical ventilation, but not duration of CPB, was independently associated with length of hospital stay. CONCLUSIONS: Early weaning from mechanical ventilation correlates with improved early Fontan haemodynamics, whereas early outcome is unrelated to duration of CPB. This indicates that early extubation may represent a principal strategy for improving early results after total cavopulmonary connection. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/29718154/Early_extubation_is_associated_with_improved_early_outcome_after_extracardiac_total_cavopulmonary_connection_independently_of_duration_of_cardiopulmonary_bypass_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezy179 DB - PRIME DP - Unbound Medicine ER -