Abstract
Objective. To identify and analyze clinical and hemodynamic predictors of unfavorable outcomes of surgical intervention in infants with congenital pathology of the aortic arch and, based on the data obtained, to create an algorithm for choosing surgical correction tactics.
Material and methods. A retrospective cohort study was conducted on 33 newborns and infants under 1 year of age with combined congenital heart disease, including pathology of the aortic arch with ductus-dependent hemodynamics, as well as with hemodynamics independent of the functioning of the patent ductus arteriosus. Clinical and hemodynamic signs that influence the outcome of surgery were identified and subjected to prognostic assessment.
Results. Statistical analysis and relationship of clinical and hemodynamic signs: systemic hypoperfusion, episodes of decreased oxygen delivery, tachypnea, pulmonary hypertension, low body weight (less than 2500 g), the need for mechanical ventilation to stabilize the patient’s condition before surgery, heart rate, blood pressure, left ventricular end-diastolic volume index with the results of surgical treatment showed that there is a direct correlation of moderate strength between these signs and an unfavorable outcome. The article substantiates and describes an algorithm for making a decision on the choice of tactics for surgical correction of the defect in newborns with pathology of the aortic arch and preoperative signs of systemic hypoperfusion. It is based on a comprehensive assessment of the main factors that have a significant impact on the outcome of surgery.
Conclusion. When developing an algorithm for deciding on surgical tactics for patient management, the following factors were taken into account: emergency intervention, mechanical ventilation, patient weight, left ventricular end-diastolic volume index. A decision-making scheme is proposed. Depending on body weight, the need for mechanical ventilation and left ventricular enddiastolic volume index, the question of the method of surgical correction is decided: radical correction with cardiopulmonary bypass (CPB), thoracotomy without CPB or hybrid intervention.
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About the authors
- Aleksey B. Naumov, Cand. Med. Sci., Associate Professor of the Department of Anesthesiology and Reanimatology; ORCID
- Olga Yu. Chupaeva, Neonatologist, Anesthesiologist-Resuscitator of the Department of Anesthesiology and Intensive Care for Children with Cardiac Surgical Pathology; ORCID
- Olga Yu. Tereshenko, Anesthesiologist-Resuscitator of the Intensive Care Unit; ORCID
- Evgeniy S. Kulemin, Cand. Med. Sci., Head of the Operating Department of the Perinatal Center, Cardiovascular Surgeon, Research Staff of Chair; ORCID
- Sergey P. Marchenko, Dr. Med. Sci., Professor, Deputy Head of the Research Center of Cardiovascular Surgery; ORCID
- Oksana V. Nevmerzhitskaya, Cand. Med. Sci., Deputy Chief Physician for Neonatology; ORCID
- Gennadiy G. Khubulava, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Head of the Research Center for Cardiovascular Surgery, Chief of Chair; ORCID
