Perioperative medicine & outcomes
Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery—A review of 148 cases
Authors' conclusion
The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups.
Study context
- Population
- Patients with hypoplastic left heart syndrome undergoing the comprehensive stage 2 procedure (hybrid approach toward Fontan circulation)
- Participants
- 148 patients
- Exposure
- Group B vs Group A
- Group Bn = 32
- Group An = 116reference
- Outcome
- Anesthetic management
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Induction agent: etomidate
- 40%
- Induction agent: esketamine
- 24%
- Induction agent: midazolam
- 16%
- Induction agent: propofol
- 13%
- Inhaled induction (only Group A)
- 2%
- Post-CPB inhaled nitric oxide
- 100%
- Post-CPB milrinone
- 97%
- Post-CPB norepinephrine
- 77%
- Group B more frequently required additional levosimendan
- 20%
- Group B more frequently required additional epinephrine
- 18%
Observational data: associations, not effects.
Further findings
Postoperative ventilation time
ICU stay
In-hospital mortality
- In-hospital mortality — Overall
- 5%
ECMO
- ECMO necessary, no between-group differences
- 8 patients (5%)
Postoperative ventilation time
- Significantly longer in Group B
- Switching from fentanyl to remifentanil reduced postoperative ventilation time overall
ICU stay
- Significantly longer in Group B
Long-term survival
- Significant advantage for Group A
Original publication
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