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Alpha-blockade during congenital heart surgery admissions: analysis from national database

Part of: Basic Science

Published online by Cambridge University Press:  17 September 2021

Brian Lee ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Emad B. Mossad ,
Jacqueline Rausa ,
Ronald A. Bronicki ,
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]  and
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]
Brian Lee
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Enrique G. Villarreal*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
Emad B. Mossad
Affiliation:
Anesthesiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Jacqueline Rausa
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Ronald A. Bronicki
Affiliation:
Critical Care and Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Saul Flores
Affiliation:
Critical Care and Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
Rohit S. Loomba
Affiliation:
Cardiology, Advocate Children’s Hospital, Chicago, IL, USA Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
*
Author for correspondence: E. G. Villarreal, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México. Tel: +811 324 4817; Fax: (832) 825-2969. E-mail: [email protected]
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Abstract

Introduction:

The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes.

Materials and Methods:

A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality.

Results:

Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges.

Conclusions:

Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

Keywords

Adrenergic alpha-antagonistsCHDsphentolaminephenoxybenzamine mortalitylength of stay
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1136 - 1142
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Sambhunath, D, Kumar, P, Kiran, U, Airan, B. Alpha blockers: a relook at phenoxybenzamine. J Pract Cardiovasc Sci 2017, 3(1):11–17.10.4103/jpcs.jpcs_42_16CrossRefGoogle Scholar
Sambhunath, D, Pankaj, K, Usha, K. Role of phenoxybenzamine in perioperative clinical practice. Ann Card Anaesth 2015; 18: 577–578.10.4103/0971-9784.166473CrossRefGoogle Scholar
Tweddell, JS, Hoffman, GM, Mussatto, KA, et al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 2002; 106: I82–9.10.1161/01.cir.0000032878.55215.bdCrossRefGoogle ScholarPubMed
Koner, Ö, Tekin, S, Köner, A, Soybir, N, Seren, S, Karaoğlu, K. Effects of phentolamine on tissue perfusion in pediatric cardiac surgery. J Cardiothorac Vasc Anesth 1999; 13: 191–197.10.1016/S1053-0770(99)90086-1CrossRefGoogle ScholarPubMed
Hoffman, GM, Tweddell, JS, Ghanayem, NS, et al. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg 2004; 127: 738–745.10.1016/S0022-5223(03)01315-1CrossRefGoogle ScholarPubMed
Kiran, U, Zuber, K, Kakani, M. Combination of low-dose phenoxybenzamine and sodium nitroprusside in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2006; 20: 291–292.10.1053/j.jvca.2005.07.034CrossRefGoogle ScholarPubMed
Kiran, U, Makhija, N, Das, SN, Bhan, A, Airan, B. Combination of phenoxybenzamine and nitroglycerin: effective control of pulmonary artery pressures in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2005; 19: 274–275.10.1053/j.jvca.2005.01.014CrossRefGoogle ScholarPubMed
Mossad, E, Motta, P, Sehmbey, K, Toscana, D. The hemodynamic effects of phenoxybenzamine in neonates, infants, and children. J Clin Anesth 2008; 20: 94–98.10.1016/j.jclinane.2007.09.006CrossRefGoogle ScholarPubMed
Bisoi, AK, Sharma, P, Chauhan, S, et al. Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation? Eur J Cardiothorac Surg 2010; 38: 707–713.10.1016/j.ejcts.2010.03.037CrossRefGoogle ScholarPubMed
De Oliveira, NC, Ashburn, DA, Khalid, F, et al. Prevention of early sudden circulatory collapse after the Norwood operation. Circulation 2004; 110: II133–II138.10.1161/01.CIR.0000138399.30587.8eCrossRefGoogle ScholarPubMed
Ithuralde, M, Neirotti, R. Neonatal heart surgery: evaluation of risk factors. NeoReviews 2011; 12: e252.10.1542/neo.12-5-e252CrossRefGoogle Scholar
Ithuralde, M, Ballestrini, M, Ithuralde, A, et al. Neonatal cardiac surgery: assessment and comparison of surgical results using the RACHS-1 risk adjustment method. Arch Argent Pediatr 2009; 107: 229–233.Google ScholarPubMed
Sakauchi, G, Anzai, T, Oki, T, Iino, A, Matsumoto, H. The application of phenoxybenzamine in open heart surgery using cardiopulmonary bypass. J Cardiovasc Surg (Torino) 1976; 17: 314–320.Google ScholarPubMed
Motta, P, Mossad, E, Toscana, D, Zestos, M, Mee, R. Comparison of phenoxybenzamine to sodium nitroprusside in infants undergoing surgery. J Cardiothorac Vasc Anesth 2005; 19: 54–59.10.1053/j.jvca.2004.11.010CrossRefGoogle ScholarPubMed
Ogawa, K, Yamamoto, T, Asada, S, et al. The effect of phenoxybenzamine on the pulmonary vascular bed in surgically corrected ventricular septal defect associated with pulmonary hypertension. Jpn Heart J 1979; 20: 157–161.10.1536/ihj.20.157CrossRefGoogle ScholarPubMed
Taylor, SH, Sutherland, GR, Mackenzie, GJ, Staunton, HP, Donald, KW. The circulatory effects of intravenous phentolamine in man. Circulation 1965; 31: 741–754.10.1161/01.CIR.31.5.741CrossRefGoogle ScholarPubMed
Rhodes, EL, O'Rourke, PT, Lee, R, Straker, J, Kirsh, MM. The effect of levarterenol and phentolamine on the hypertensive pulmonary vasculature. Ann Thorac Surg 1973; 16: 375–379.10.1016/S0003-4975(10)65008-4CrossRefGoogle ScholarPubMed
Ruskin, JN, Hutter, AM Jr. Primary pulmonary hypertension treated with oral phentolamine. Ann Intern Med 1979; 90: 772–774.10.7326/0003-4819-90-5-772CrossRefGoogle ScholarPubMed
Jones, CE, Liang, IY, Maulsby, MR. Cardiac and coronary effects of prazosin and phenoxybenzamine during coronary hypotension. J Pharmacol Exp Ther 1986; 236: 204–211.Google ScholarPubMed
O'Blenes, SB, Roy, N, Konstantinov, I, Bohn, D, Van Arsdell, GS. Vasopressin reversal of phenoxybenzamine-induced hypotension after the Norwood procedure. J Thorac Cardiovasc Surg 2002; 123: 1012–1013.10.1067/mtc.2002.122207CrossRefGoogle ScholarPubMed
Morozova, O, Levina, O, Uusküla, A, Heimer, R. Comparison of subset selection methods in linear regression in the context of health-related quality of life and substance abuse in Russia. BMC Med Res Methodol 2015; 15: 71.10.1186/s12874-015-0066-2CrossRefGoogle ScholarPubMed
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