The acute influence of vasopressin on hemodynamic status and tissue oxygenation following the Norwood procedure

Ronald A Bronicki; Sebastian Acosta; Fabio Savorgnan; Saul Flores; Barbara-Jo Achuff; Rohit Loomba; Mubbasheer Ahmed; Nancy Ghanayem; Jeffrey S Heinle; Vicken Asadourian; Javier J Lasa

doi:10.1016/j.xjon.2022.01.008

The acute influence of vasopressin on hemodynamic status and tissue oxygenation following the Norwood procedure

JTCVS Open. 2022 Jan 22:9:217-224. doi: 10.1016/j.xjon.2022.01.008. eCollection 2022 Mar.

Affiliations

¹ Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
² Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
³ Division of Pediatric Cardiology, Department of Pediatrics, Advocate Children's Hospital, Chicago Medical School/Rosalind Franklin University of Medicine, Oak Lawn, Ill.
⁴ Section of Critical Care Medicine, Comer Children's Hospital, University of Chicago School of Medicine, Chicago, Ill.
⁵ Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
⁶ Medical Informatics Corporation, Houston, Tex.

Abstract

Objectives: Arginine vasopressin (AVP) is used to treat hypotension. Because AVP increases blood pressure by increasing systemic vascular resistance, it may have an adverse effect on tissue oxygenation following the Norwood procedure.

Methods: Retrospective analysis of continuously captured hemodynamic data of neonates receiving AVP following the Norwood procedure.

Results: We studied 64 neonates exposed to AVP within 7 days after the Norwood procedure. For the entire group, AVP significantly increased mean blood pressure (2.5 ± 6.3) and cerebral and renal oxygen extraction ratios (4.1% ± 9.6% and 2.0% ± 4.7%, respectively; P < .001 for all values). In the right ventricle to pulmonary artery shunt cohort, AVP significantly increased blood pressure, arterial oxygen saturation (1.4% ± 3.8%; P = .011), pulmonary to systemic perfusion ratio (0.2 ± 0.4; P = .017), and cerebral and renal oxygen extraction ratios (4.6% ± 8.7%; P = .010% and 4.7% ± 9.4%; P = .014, respectively). The Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in arterial oxygen saturation, pulmonary to systemic perfusion ratio, or cerebral and renal oxygen extraction ratios.

Conclusions: The right ventricle to pulmonary artery shunt cohort experienced a significant vasopressor response to AVP that was associated with a significant increase in pulmonary perfusion and decrease in cerebral and renal perfusion, whereas the Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in pulmonary or systemic perfusion. The influence of AVP on tissue oxygenation following the Norwood procedure may have clinical implications that require further study.

Keywords: ANOVA, analysis of variance; AVP, arginine vasopressin; BP, blood pressure; BTS, Blalock-Taussig shunt; CAP, common atrial pressure; CO, cardiac output; CPP, coronary perfusion pressure; HR, heart rate; NIRS, near infrared spectroscopy; NP, Norwood procedure; Norwood procedure; O2ER, oxygen extraction ratio; PVR, pulmonary vascular resistance; Qp, pulmonary perfusion; Qs, systemic perfusion; RVPAS, right ventricular to pulmonary artery shunt; SS, steady state; SVR, systemic vascular resistance; Sao2, arterial oxygen saturation; TSS, time to steady state; VIS, vasoactive infusion score; afterload; near infrared spectroscopy oximetry; oxygen delivery; pulmonary to systemic perfusion ratio; single ventricle; vasopressin.