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Preprint ARTICLE | doi:10.20944/preprints202308.1985.v1

Analysis of P(v-a)CO2/C(a-v)O2 Ratio and Other Perfusion Markers in a Population of 98 Pediatric Patients Undergoing Cardiac Surgery

Matteo Taiana, Irene Tomasella, Alessandro Russo, Annalisa Lerose, Marcello ceola Graziadei, Luisa Corubolo, Jacopo Rama, Vittorio Schweiger, A Vignola, Enrico Polati, Giovanni Battista Luciani, Francesco Onorati, Katia Donadello, Leonardo Gottin

Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: Venoarterial carbon dioxide difference; congenital heart disease; cardiopulmonary bypass; post-operative care; physiologic monitoring, infant

Online: 29 August 2023 (14:20:31 CEST)

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BACKGROUNDː The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for a better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable to identify a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio [P(v-a)CO2/C(a-v)O2] can be a good index to predict the development of LCOS in the aforemen-tioned patients, so as to treat it promptly. METHODSː This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Inte-grated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analysis were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to intensive care unit, before and after extubation and at any time of instability or modification of the patient’s clinical and therapeutic conditions. RESULTSː The data analysis shows that 46.9% of the children developed a LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2/C(a-v)O2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. CONCLUSIONSː This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2 and oxygen extraction ratio-ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with he-modynamic instability before surgery.

Preprint ARTICLE | doi:10.20944/preprints202311.0661.v1

Survival and Recurrence of Endocarditis Following Mechanical vs. Biological Aortic Valve Replacement in Patients Aged 40 to 65 Years: Data from the INFECT-REGISTRY

Antonio Salsano, Michele Di Mauro, Laura Labate, Alessandro Della Corte, Federica Lo Presti, Michele De Bonis, Cinzia Trumello, Mauro Rinaldi, Erik Cura Stura, Guglielmo Actis Dato, Giuseppe Punta, Francesco Nicolini, Davide Carino, Carlo De Vincentiis, Andrea Garatti, Giangiuseppe Cappabianca, Andrea M Musazzi, Diego Cugola, Maurizio Merlo, Davide Pacini, Gianluca Folesani, Sandro Sponga, Igor Vendramin, Alberto Pilozzi Casado, Francesco Rosato, Elisa Mikus, Carlo Savini, Francesco Onorati, Giovanni Battista Luciani, Roberto Scrofani, Francesco Epifani, Francesco Musumeci, Antonio Lio, Andrea Colli, Giosuè Falcetta, Salvatore Nicolardi, Salvatore Zaccaria, Enrico Vizzardi, Antonio Pantaleo, Giuseppe Minniti, Emmanuel Villa, Margherita Dalla Tomba, Francesco Pollari, Fabio Barili, Alessandro Parolari, Roberto Lorusso, Francesco Santini

Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: endocarditis; aortic valve replacement; prosthetic heart valve.

Online: 9 November 2023 (15:01:57 CET)

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