Pediatric Intensive Care Unit, Women Mother and Child Department, Lausanne University Hospital, Lausanne, Switzerland.
Pediatric Cardiology Unit, Women Mother and Child Department, Lausanne University Hospital, Lausanne, Switzerland.
Eur J Pediatr. 2024 Aug;183(8):3309-3317. doi: 10.1007/s00431-024-05597-1. Epub 2024 May 9.
Tetralogy of Fallot is the most common cyanotic congenital heart disease. For decades, our institution has cared for humanitarian patients with late presentation of tetralogy of Fallot. They are characterized by severe right ventricular hypertrophy with consecutive diastolic dysfunction, increasing the risk of postoperative low cardiac output syndrome (LCOS). By right ventricular restrictive physiology, we hypothesized that patients receiving early postoperative beta-blockers (within 48 h after cardiopulmonary bypass) may have better diastolic function and cardiac output. This is a retrospective cohort study in a single-center tertiary pediatric intensive care unit. We included > 1-year-old humanitarian patients with a confirmed diagnosis of tetralogy of Fallot undergoing a complete surgical repair between 2005 and 2019. We measured demographic data, preoperative echocardiographic and cardiac catheterization measures, postoperative mean heart rate, vasoactive-inotropic scores, LCOS scores, length of stay, and mechanical ventilation duration. One hundred sixty-five patients met the inclusion criteria. Fifty-nine patients (36%) received early postoperative beta-blockers, associated with a lower mean heart rate, higher vasoactive-inotropic scores, and lower LCOS scores during the first 48 h following cardiopulmonary bypass. There was no significant difference in lengths of stay and ventilation. Conclusion: Early postoperative beta-blockers lower the prevalence of postoperative LCOS at the expense of a higher need for vasoactive drugs without any consequence on length of stay and ventilation duration. This approach may benefit the specific population of children undergoing a late complete repair of tetralogy of Fallot. What is Known: • Prevalence of low cardiac output syndrome is high following a late complete surgical repair of tetralogy of Fallot. What is New: • Early postoperative beta-blockade is associated with lower heart rate, prolonged relaxation time, and lower prevalence of low cardiac output syndrome. • Negative chronotropic agents like beta-blockers may benefit selected patients undergoing a late complete repair of tetralogy of Fallot, who are numerous in low-income countries.
法洛四联症是最常见的发绀型先天性心脏病。几十年来，我们机构一直照顾那些出现晚期法洛四联症的人道主义患者。他们的特点是严重的右心室肥厚伴有随后的舒张功能障碍，增加了术后低心输出量综合征（LCOS）的风险。通过右心室限制生理，我们假设在体外循环后 48 小时内（术后早期）接受β受体阻滞剂的患者可能具有更好的舒张功能和心输出量。这是一项在单中心三级儿科重症监护病房进行的回顾性队列研究。我们纳入了 2005 年至 2019 年间接受完全手术修复的确诊为法洛四联症的＞1 岁人道主义患者。我们测量了人口统计学数据、术前超声心动图和心导管检查结果、术后平均心率、血管活性-正性肌力评分、LCOS 评分、住院时间和机械通气时间。165 名患者符合纳入标准。59 名患者（36%）接受了术后早期β受体阻滞剂治疗，与体外循环后 48 小时内的平均心率较低、血管活性-正性肌力评分较高和 LCOS 评分较低相关。住院时间和通气时间无显著差异。结论：术后早期β受体阻滞剂可降低术后 LCOS 的发生率，代价是更高的血管活性药物需求，但对住院时间和通气时间无影响。这种方法可能对接受晚期完全修复法洛四联症的儿童特定人群有益。已知：•晚期完全手术修复法洛四联症后低心输出量综合征的发生率较高。新发现：•术后早期β受体阻滞剂与较低的心率、较长的舒张时间和较低的低心输出量综合征发生率相关。•β受体阻滞剂等负性变时药物可能有益于接受晚期完全修复法洛四联症的选定患者，这些患者在低收入国家很多。
