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Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study

Une pulsatilité de la veine porte plus élevée est associée à de moins bons devenirs cliniques après une chirurgie cardiaque congénitale : une étude de cohorte prospective monocentrique

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Abstract

Purpose

Increased portal venous flow pulsatility is associated with major complications after adult cardiac surgery. Nevertheless, no data are available for pediatric patients with congenital heart disease. We hypothesized that Doppler parameters including portal flow pulsatility could be associated with postoperative outcomes in children undergoing various cardiac surgeries.

Methods

We conducted a prospective observational cohort study in children undergoing congenital cardiac surgery. We obtained postoperative portal, splenic, and hepatic venous Doppler data and perioperative clinical data including major postoperative complications. Portal and splenic venous flow pulsatility were calculated. We evaluated the association between venous Doppler parameters and adverse outcomes. The primary objective was to determine whether postoperative portal flow pulsatility could indicate major complications following congenital heart surgery.

Results

In this study, we enrolled 389 children, 74 of whom experienced major postoperative complications. The mean (standard deviation) portal pulsatility (44 [30]% vs 25 [14]%; 95% confidence interval [CI] for mean difference, 12 to 26; P < 0.001] and splenic pulsatility indices (41 [30]% vs 26 [16]%; 95% CI, 7 to 23; P < 0.001) were significantly higher in children with postoperative complications than in those without complications. The portal pulsatility index was able to help identify postoperative complications in biventricular patients and univentricular patients receiving bidirectional cavopulmonary shunt whereas it did not in other univentricular patients. An increased postoperative portal pulsatility index was significantly associated with major complications after pediatric cardiac surgery (odds ratio, 1.40; 95% CI, 1.29 to 1.91; P < 0.001).

Conclusions

Higher portal venous pulsatility is associated with major postoperative complications in children undergoing cardiac surgery. Nevertheless, more data are needed to conclude the efficacy of portal venous pulsatility in patients with univentricular physiology.

Study registration

ClinicalTrials.gov (NCT03990779); registered 19 June 2019.

Résumé

Objectif

L’augmentation de la pulsatilité du flux de la veine porte est associée à des complications majeures après une chirurgie cardiaque chez l’adulte. Néanmoins, aucune donnée n’est disponible pour la patientèle pédiatrique atteinte de cardiopathie congénitale. Nous avons émis l’hypothèse que les paramètres Doppler, y compris la pulsatilité du flux de la veine porte, pourraient être associés aux devenirs postopératoires des enfants bénéficiant de diverses chirurgies cardiaques.

Méthode

Nous avons réalisé une étude de cohorte observationnelle prospective portant sur des enfants bénéficiant d’une chirurgie cardiaque congénitale. Nous avons obtenu des données Doppler des veines porte, spléniques et hépatiques postopératoires ainsi que des données cliniques périopératoires, y compris les complications postopératoires majeures. La pulsatilité du flux des veines porte et spléniques a été calculée. Nous avons évalué l’association entre les paramètres Doppler veineux et les issues indésirables. L’objectif principal était de déterminer si la pulsatilité du flux postopératoire de la veine porte pouvait constituer un indicateur des complications majeures après une chirurgie cardiaque congénitale.

Résultats

Dans cette étude, nous avons recruté 389 enfants, dont 74 ont présenté des complications postopératoires majeures. La pulsatilité moyenne de la veine porte (écart type) (44 [30] % vs 25 [14] %; intervalle de confiance [IC] à 95 % pour la différence moyenne, 12 à 26; P < 0,001] et les indices de pulsatilité splénique (41 [30] % vs 26 [16] %; IC 95 %, 7 à 23; P < 0,001) étaient significativement plus élevés chez les enfants présentant des complications postopératoires que chez les enfants sans complications. L’indice de pulsatilité de la veine porte a permis d’identifier les complications postopératoires chez les patient·es biventriculaires et les patient·es univentriculaires recevant une anastomose cavo-pulmonaire bidirectionnelle (procédure de Glenn), alors que ce n’était pas le cas chez les autres patient·es univentriculaires. Une augmentation postopératoire de l’indice de pulsatilité de la veine porte était significativement associée à des complications majeures après une chirurgie cardiaque pédiatrique (rapport de cotes, 1,40; IC 95 %, 1,29 à 1,91; P < 0,001).

Conclusion

Une pulsatilité plus élevée de la veine porte est associée à des complications postopératoires majeures chez les enfants bénéficiant d’une chirurgie cardiaque. Néanmoins, davantage de données sont nécessaires pour conclure à l’efficacité de la pulsatilité de la veine porte chez les patient·es présentant une physiologie univentriculaire.

Enregistrement de l’étude

ClinicalTrials.gov (NCT03990779); enregistrée le 19 juin 2019.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Ji-Hyun Lee MD, PhD, Pyoyoon Kang MD, Hee-Won Kim MD, Sang-Hwan Ji MD, PhD, Young-Eun Jang MD, PhD, Eun-Hee Kim MD, PhD, Hee-Soo Kim MD, PhD & Jin-Tae Kim MD, PhD

  2. Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada

    André Y. Denault MD, PhD

  3. Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC, Canada

    William Beaubien-Souligny MD, PhD

  4. Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea

    Jay Kim MD

  5. Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, South Korea

    Jin-Tae Kim MD, PhD

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  1. Ji-Hyun Lee MD, PhD
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Corresponding author

Correspondence to Jin-Tae Kim MD, PhD.

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Author contributions

Jin-Tae Kim and André Y. Denault contributed to study conception and design. Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Pyoyoon Kang, Jay Kim, and Hee-Won Kim contributed to data acquisition. Young-Eun Jang, Hee-Soo Kim, Jay Kim, and Hee-Won Kim contributed to data analysis and interpretation. Ji-Hyun Lee and Jin-Tae Kim contributed to drafting the manuscript. André Y. Denault and William Beaubien-Souligny contributed to revising the manuscript. All authors contributed to the accuracy and integrity of the data.

Disclosures

The authors declare no competing interests.

Funding statement

Support was solely from institutional and/or departmental sources.

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This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Lee, JH., Denault, A.Y., Beaubien-Souligny, W. et al. Higher portal venous pulsatility is associated with worse clinical outcomes following congenital heart surgery: a single-centre prospective cohort study. Can J Anesth/J Can Anesth 70, 1957–1969 (2023). https://doi.org/10.1007/s12630-023-02605-0

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