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Pediatric Cardiology

, Volume 40, Issue 3, pp 468–476 | Cite as

Extubation in the Operating Room After Fontan Procedure: Does It Make a Difference?

  • Sebastian Kintrup
  • Edward Malec
  • Daniela Kiski
  • Christoph Schmidt
  • Andreas Brünen
  • Felix Kleinerüschkamp
  • Hans-Gerd Kehl
  • Katarzyna JanuszewskaEmail author
Original Article

Abstract

Early extubation appears to have beneficial effects on the Fontan circulation. The goal of this study was to assess the impact of extubation on the operating table in comparison with extubation during the first hours after Fontan operation (FO) on the early postoperative course. Between 2013 and 2016, 114 children with a single ventricle heart malformations (mean age, 3.8 ± 2.3 years) underwent FO: 60 patients were extubated in the operating room (ORE) and 54 in the intensive care unit (ICUE) in the median time of 195 min (range 30–515 min) after procedure. Pre-, peri-, and postoperative records were retrospectively analyzed. The hospital survival rate was 100%. One patient from the ORE group needed an immediate reintubation because of laryngospasm. The ORE group showed lower heart rate (106.5 vs. 120.3 bpm; p < 0.001) and lower central venous pressure (10.4 vs. 11.4 mmHg; p = 0.001) than patients in the ICUE group within the first 24 h after FO, as well as higher systolic blood pressure within 7 h after operation (88.6 ± 2.5 vs. 85.6 ± 2.6 mmHg; p = 0.036). The ORE children manifested significantly less pleural effusions during 48 h after FO (38.0 vs. 49.5 ml/kg; p = 0.004), received less intravenous fluid administration within 24 h after FO (54.1 vs. 73.8 ml/kg; p = 0.019), less inotropic support (9.8 vs. 12.8 h of dopamine; p = 0.033), and less antibiotics (4.7 vs. 5.8 days; p = 0.037). ICUE children manifested metabolic acidosis more frequently than the ORE group 3–4 h after FO (p < 0.05). Immediate extubation after FO in comparison with extubation in the ICU appears to be associated with improved hemodynamics and reduced application of therapeutic interventions in the postoperative course.

Keywords

Fontan operation Single ventricle Congenital cardiac defects Extubation 

Abbreviations

ALT

Alanine transaminase

AST

Aspartate transaminase

AV

Atrioventricular

BAP

Balloon angioplasty

BGA

Blood gas analysis

BSA

Body surface area

BT

Blalock–Taussig

CoAo

Coarctation of the aorta

CPB

Cardiopulmonary bypass

DILV

Double-inlet left ventricle

FO

Fontan operation

GGTP

Gamma-glutamyl transferase

HLHS

Hypoplastic left heart syndrome

HRHS

Hypoplastic right heart syndrome

ICUE

Intensive care unit extubation

IVC

Inferior vena cava

LCOS

Low cardiac output syndrome

LPA

Left pulmonary artery

MAPCA

Major aortopulmonary collateral artery

mPAP

Mean pulmonary artery pressure

ORE

Operating room extubation

PTFE

Polytetrafluoroethylene

RPA

Right pulmonary artery

RV–PA

Right ventricle to pulmonary artery

Sat

Saturation

SV

Single ventricle

SVC

Superior vena cava

SVEDP

Single ventricle end diastolic pressure

TPG

Transpulmonary pressure gradient

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric Cardiac SurgeryUniversity Hospital MuensterMuensterGermany
  2. 2.Department of Pediatric CardiologyUniversity Hospital MuensterMuensterGermany
  3. 3.Department of AnesthesiologyUniversity Hospital MuensterMuensterGermany

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