Η επίδραση της λεβοσιμενδάνης σε παιδιά με μυοκαρδίτιδα – μυοκαρδιοπάθεια και καρδιακή ανεπάρκεια.

Εισαγωγή: Η συχνότερη αιτία καρδιακής ανεπάρκειας σε παιδιά με ανατομικά φυσιολογική καρδιά είναι η μυοκαρδιοπάθεια. Τα δεδομένα για την αποτελεσματικότητα της λεβοσιμενδάνης στον πληθυσμό αυτό είναι πολύ πτωχά. Σκοποί και υποθέσεις: Οι σκοποί της παρούσας μελέτης είναι η παρουσίαση των επιδημιολογικών χαρακτηριστικών παιδιατρικών ασθενών με καρδιακή ανεπάρκεια απότοκη μυοκαρδιοπάθειας / μυοκαρδίτιδας, η αναγνώριση πιθανών παραγόντων κινδύνου και η εκτίμηση της πιθανής αποτελεσματικότητας χορήγησης λεβοσιμενδάνης στον μελετώμενο πληθυσμό. Υλικό και μέθοδος: Αναδρομική μελέτη ανασκόπησης των ιατρικών αρχείων παιδιατρικών ασθενών με καρδιακή ανεπάρκεια και διάγνωση μυοκαρδιοπάθειας – μυοκαρδίτιδας, που νοσηλεύτηκαν στο Ωνάσειο Καρδιοχειρουργικό Κέντρο το διάστημα 2004-2017. Αποτελέσματα: Συνολικά μελετήθηκαν 75 ασθενείς. Η διάμεση διάρκεια παρακολούθησης των ασθενών ήταν 24.1 μήνες (IQR 8,3-85,9). Αναγνωρίστηκαν πολλαπλοί παράγοντες κινδύνου για δυσμενή έκβαση (αθροιστικά επιδείνωση, παραπομπή προς μεταμόσχευση, θάνατος), αλλά και ξεχωριστά θάνατο. Αναλύθηκαν δεδομένα από 16 ασθενείς που έλαβαν λεβοσιμενδάνη [σύνολο 265 εγχύσεις με διάμεση τιμή 12 εγχύσεις/ασθενή (IQR 9-24)]. Η χορήγηση λεβοσιμενδάνης ήταν καλώς ανεκτή και συσχετίστηκε με βελτίωση του κλάσματος βράχυνσης (p=0.003), καθώς επίσης και ελάττωση των τιμών NT-pro-BNP (p=0.033). Συμπεράσματα: Στην παρούσα μελέτη η χορήγηση επαναλαμβανόμενων δόσεων λεβοσιμενδάνης σε παιδιά με καρδιακή ανεπάρκεια απότοκη μυοκαρδίτιδας ή μυοκαρδιοπάθειας ήταν ασφαλής και σχετίστηκε με βελτίωση της λειτουργικότητας της αριστερής κοιλίας και ελάττωση των τιμών NT-proBNP.Introduction: The commonest cause of heart failure in children with anatomically intact heart is cardiomyopathy. Data regarding effectiveness of levosimendan in this group of patients is limited. Purpose: The aims of this study were to present the epidemiologic data of paediatric patients with heart failure secondary to cardiomyopathy, to identify potential risk factors predictive of outcome and to retrospectively evaluate the possible effect of levosimendan administration in this particular group of patients. Materials and methods: Retrospective cohort study of paediatric patients with heart failure secondary to cardiomyopathy – myocarditis, who were hospitalized in Onassis Cardiac Surgery Centre, Athens, Greece, during 2004-2017. Results: Seventy five patients were included in the study. Median follow up was 24.1 months (IQR 8,3-85,9). Multiple risk factors were identified for adverse outcome (composite endpoint of deterioration, transplantation listing and death) and death. Sixteen patients who received in total 265 levosimendan infusions [median 12 infusions/patient (IQR 9-24)] were analyzed. Levosimendan infusions were safe and associated with significant improvement of LV shortening fraction (p=0.003) and significant reduction of NT-proBNP values (p=0.033). Conclusions: In our study, repeated levosimendan infusions in children with heart failure due to cardiomyopathy – myocarditis were safe and associated with significant improvement of LV function and significant reduction of NT-proBNP values

Outcomes of delayed chest closure after congenital heart surgery in neonates

We present the outcomes of delayed chest closure in neonates who underwent congenital heart surgery under cardiopulmonary bypass. Eighty-one consecutive neonatal patients (age ≤ 28 days) with congenital heart diseases who underwent heart operations and after surgery, chest remained open in the intensive care unit until DCC. Correction of transposition of the great arteries pathology was the most common surgical procedure (48.1% of patients). Median sternal closure time from surgery was 3 (2-4) days. Median age of neonates was 9 (5-12) days. In addition, in 4 cases (4.9%) there was secretion from the surgical site after DCC and after taking cultures, in 2 (2.4%) of the cases a pathogen was identified. Multivariable linear regression analysis (adjusted to gender and CPB) showed that only the age-predicted the sternum closure time (β=-0.09, 95%CI: - 0.16 to -0.02, p=0.02). In-hospital mortality was 6 (7.4%) patients. Although the DCC in neonates who underwent CHD surgical correction was related to a high mortality rate, only the age of neonates predicted the sternum closure time in the ICU

Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery—Current Aspects in Diagnosis and Treatment

Postoperative chylothorax is a rare complication following cardiac surgery for congenital heart disease (CHD) in the pediatric population, including neonates and infants. Multiple mechanisms are involved in the development of postoperative chylous effusions, mainly the traumatic injury of lymphatic vessels, systemic venous obstruction and dysfunction of the right ventricle. In this review, we focus on the existing evidence regarding the definition and diagnosis of postoperative chylothorax in children with CHD, as well as current therapeutic approaches, both nutritional and interventional, for the management of these patients. As part of nutritional management, we specifically comment on the use of defatted human milk and its effect on both chylothorax resolution and patient growth. A consensus with regard to several key aspects of this potentially significant complication is warranted given its impact on the cost, morbidity and mortality of children with CHD

Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

Patent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution’s experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012- January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birthwas 27.9 +/- 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8-12); PDA diameter 3.4mm (IQR: 3.2- 3.5); surgical weight (SW) 750 g (IQR: 680-850); and days of mechanical ventilation (DMV) as estimated by Kaplan-Meier curve 22 days (95% confidence interval: 14.2-29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = - 0.587, p = 0.017), SA (rho = - 0.629, p = 0.009) and SW (rho = - 0.737, p = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBWinfants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants

Acute Kidney Injury Predictors and Outcomes after Cardiac Surgery in Children with Congenital Heart Disease: An Observational Cohort Study

Acute Kidney Injury (AKI) commonly complicates cardiac surgery in children with congenital heart disease (CHD). In this study we assessed incidence, risk factors, and outcomes of postoperative AKI, while testing the hypothesis that, depending on the underlying diagnosis, there would be significant differences in AKI incidence among different diagnostic groups. We conducted an observational cohort study of children with CHD undergoing cardiac surgery in a single tertiary center between January 2019 and August 2021 (n = 362). Kidney Disease Improving Global Outcome (KDIGO) criteria were used to determine the incidence of postoperative AKI. Diagnosis was incorporated into multivariate models using an anatomic-based CHD classification system. Overall survival was estimated using Kaplan–Meier curves. Log-rank test and adjusted Cox proportional hazard modelling were used to test for differences in survival distributions and determine AKI effect on survival function, respectively. AKI occurred in 70 (19.3%), with 21.4% in-hospital mortality for AKI group. Younger age, lower weight, longer cardiopulmonary bypass time, preoperative mechanical ventilation and diagnostic category were associated with postoperative AKI. Resolution rate was 92.7% prior to hospital discharge for survivors. AKI was associated with longer duration of mechanical ventilation, ICU and hospital length of stay. AKI patients had significantly higher probability of all-cause mortality postoperatively when compared to the non-AKI group (log-rank test, p < 0.001). Adjusted hazard ratio for AKI versus non-AKI group was 11.08 (95% CI 2.45–50.01; p = 0.002). Diagnostic category was associated with cardiac surgery-related AKI in children with CHD, a finding supporting the development of lesion specific models for risk stratification. Postoperative AKI had detrimental impact on clinical outcomes and was associated with decreased survival to hospital discharge