Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular septal defects repair: A retrospective cohort study

Jimi Oh; Byungdoo Andrew Lee; Won-Jung Shin; DaUn Jeong; Tae-Jin Yun; Chun Soo Park; Eun Seok Choi; In-Kyung Song

doi:10.1111/pan.14277

Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular septal defects repair: A retrospective cohort study

Paediatr Anaesth. 2021 Nov;31(11):1216-1224. doi: 10.1111/pan.14277. Epub 2021 Aug 27.

Authors

Jimi Oh¹, Byungdoo Andrew Lee², Won-Jung Shin², DaUn Jeong³, Tae-Jin Yun⁴, Chun Soo Park⁴, Eun Seok Choi⁴, In-Kyung Song²

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
² Laboratory for Cardiovascular Dynamics, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
³ Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁴ Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

PMID: 34398480
DOI: 10.1111/pan.14277

Abstract

Background: Ventricular-arterial coupling is the ratio of arterial elastance to ventricular end-systolic elastance.

Aims: The objective of this study was to determine the clinical implication of intraoperative ventricular-arterial coupling derived from the pressure-area relationship using transesophageal echocardiography.

Methods: This retrospective study reviewed the medical records of 72 pediatric patients with ventricular septal defects who underwent corrective surgery with cardiopulmonary bypass. The single-beat modified method was used to assess ventricular-arterial coupling. Logistic regression analyses were performed to determine the correlation between ventricular-arterial coupling and early postoperative outcomes, including the maximum vasoactive-inotropic score, length of mechanical ventilation, and length of hospital stay.

Results: Ventricular-arterial coupling after cardiopulmonary bypass significantly increased (from 1.0 ± 0.4 to 1.4 ± 0.8, p < .001), indicating a disproportionate increase in the arterial elastance index (from 11.5 ± 5.1 to 19.8 ± 7.5 mmHg/cm² /m² , p < .001) compared with the ventricular end-systolic elastance index (from 13.0 ± 6.9 to 16.9 ± 9.0 mmHg/cm² /m² , p < .001). Logistic regression analyses revealed that high postoperative ventricular-arterial coupling was independently associated with higher postoperative maximum vasoactive-inotropic score (>10; odds ratio [OR], 8.04; 95% confidence interval [CI], 1.38-46.85, p = .020), longer postoperative mechanical ventilation (>15 h; OR: 11.00; 95% CI: 1.26-96.45, p = .030), and longer postoperative hospital stay (>7 days; OR: 2.98; 95% CI: 1.04-8.58, p = .043).

Conclusions: Ventricular-arterial coupling can be easily obtained from the intraoperative transesophageal echocardiography in pediatric patients undergoing ventricular septal defects repair. High postoperative ventricular-arterial coupling is strongly associated with worse early postoperative outcomes. Ventricular-arterial coupling shows promise as an intraoperative analysis tool that can provide insight into the impact of interventions on cardiovascular performance and identify potential targets for treatment in this population.

Keywords: cardiac surgery; congenital; echocardiography; heart defects; inotropic agents; positive cardiac.

MeSH terms

Cardiopulmonary Bypass
Child
Echocardiography
Heart Septal Defects, Ventricular* / diagnostic imaging
Heart Septal Defects, Ventricular* / surgery
Heart Ventricles* / diagnostic imaging
Humans
Retrospective Studies