Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T11:08:15.188Z Has data issue: false hasContentIssue false
  • English
  • Français

Safety and utility of passive peritoneal drainage following Fontan palliation

Published online by Cambridge University Press:  04 June 2013

Chaya Pitman-Hunt ,
Kristen L. Richards ,
Ralph E. Delius ,
Henry L. Walters III  and
Christopher W. Mastropietro
Chaya Pitman-Hunt
Affiliation:
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Kristen L. Richards
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Christopher W. Mastropietro*
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
*
Correspondence to: C. W. Mastropietro, Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan, Wayne State University, Carl's Building, 4th floor, 3901 Beaubien Street, Detroit, Michigan 48201, United States of America. Tel: +313 745 7495; Fax: +313 966 0103; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: Placement of peritoneal drainage catheters intra-operatively has been shown to help prevent fluid overload in children recovering from surgery for two-ventricle heart disease. We aimed to determine whether this practice is also helpful in children recovering from Fontan palliation. Material and methods: A retrospective review was performed on children with single-ventricle anatomy undergoing Fontan palliation at our institution from 2007 to 2011. Variables in those with peritoneal drainage were compared with those without using t-tests, Mann–Whitney U-tests, chi-square tests, or analysis of variance for repeated measures as appropriate. Data were represented as mean with standard deviation unless otherwise noted. Results: A total of 43 children were reviewed, 21 (49%) with peritoneal drainage catheters. No complications from catheter placement occurred. The groups did not differ with regard to cardiopulmonary bypass duration, dominant ventricle, pre-operative haemodynamic data, fenestration use, and initial intensive care unit ventilation index. Central venous pressures, vasoactive medication use, and diuretic use during the first 48 hours were also not statistically different. At 48 hours, the median fluid balance was −9 (interquartile range : −50, +20) in those with peritoneal drainage and +77 cc/kg (interquartile range : +22, +96) in those without (p < 0.001), yet median duration of mechanical ventilation was 40 hours (range: 19–326) in those with peritoneal drainage and 23 hours (range: 9–92) in those without, p = 0.01. Conclusion: Patients with peritoneal drainage recovering from Fontan palliation achieved negative fluid balance as compared with those without peritoneal drainage, although this difference was associated with a longer duration of mechanical ventilation.

Keywords

Congenital heart diseasepaediatricpost-operative careFontan
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 3 , June 2014 , pp. 503 - 509
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Maehara, T, Novak, I, Wyse, RKH, Elliot, MJ. Perioperative monitoring of total body water by bioelectrical impedance in children undergoing open heart surgery. Eur J Cardiothorac Surg 1991; 5: 258–265.Google Scholar
2. Bennett, M, Dent, CL, Ma, Q, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008; 3: 665–673.Google Scholar
3. Khabar, KS, El Barbary, MA, Khouqeer, F, Devol, E, Al-Gain, S, Al-Halees, Z. Circulating endotoxin and cytokines after cardiopulmonary bypass: differential correlation with duration of bypass and systemic inflammatory response/multiple organ dysfunction syndromes. Clin Immunol Immunopathol 1997; 85: 97–103.Google Scholar
4. Seghaye, MC, Grabitz, RG, Duchateau, J, et al. Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations. J Thorac Cardiovasc Surg 1996; 112: 687–697.Google Scholar
5. Seghaye, MC. The clinical implications of the systemic inflammatory reaction related to cardiac operations in children. Cardiol Young 2003; 13: 228–239.Google Scholar
6. Mahmoud, AS, Burhani, MS, Hannef, AA, Jamjoom, AA, Al-Githmi, IS, Baslaim, GM. Effect of modified ultrafiltration on pulmonary function after cardiopulmonary bypass. Chest 2005; 128: 3447–3453.Google Scholar
7. Stromberg, D, Fraser, CD Jr, Sorof, JM, Drescher, K, Feltes, TF. Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management. Tex Heart Inst J 1997; 24: 269–277.Google ScholarPubMed
8. Werner, HA, Wensley, DF, Lirenman, DS, LeBlanc, JG. Peritoneal dialysis in children after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1997; 113: 64–70.Google Scholar
9. Dittrich, S, Dähnert, I, Vogel, M, et al. Peritoneal dialysis after infant open heart surgery, observations in 27 patients. Ann Thorac Surg 1999; 68: 160–163.Google Scholar
10. Pedersen, KR, Hjortdal, VE, Christensen, S, et al. Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl 2008; 108: S81–S86.Google Scholar
11. Chin, JC, Hwang, BT, Weng, ZC, et al. Peritoneal dialysis in infants and children after open heart surgery. Pediatr Neonatol 2009; 50: 275–279.Google Scholar
12. Bokesch, PM, Kapural, MB, Mossad, EB, et al. Do peritoneal catheters remove pro-inflammatory cytokines after cardiopulmonary bypass in neonates? Ann Thorac Surg 2000; 70: 639–643.Google Scholar
13. Saini, A, Delius, RE, Seshadri, S, Walters, H, Mastropietro, C. Passive peritoneal drainage improves fluid balance after surgery for congenital heart disease. European J of Cardiothorac Surg 2012; 41: 256–260.Google Scholar
14. Malm, T, Pawade, A, Karl, TR, Mee, RB. Recent results with the modified Fontan operation. Scand Cardiovascr J 1993; 27: 65–70.Google Scholar
15. Amodeo, A, Galletti, L, Marianeschi, S, et al. Extracardiac Fontan operation for complex cardiac anomalies: seven years’ experience. J Thorac Cardiovasc Surg 1997; 114: 1020–1030.Google Scholar
16. Azakie, A, McCrindle, BW, Van Arsdell, G, et al. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 2001; 122: 1219–1228.Google Scholar
17. Jitendra, V, Reddy, DB, Kumar, N. Management of post-Fontan chylothorax with non-valved silastic conduit. Asian Cardiovasc Thorac Ann 2001; 9: 243–245.Google Scholar
18. Suominen, PK, Pakarinen, MP, Rautiainen, P, Mattila, I, Sairanen, H. Comparison of direct and intravesical measurement of intraabdominal pressure in children. J Pediatr Surg 2006; 41: 1381–1385.Google Scholar
19. Hamamoto, M, Uemura, H, Imanaka, H, Yagihara, T. Relevance of the measurement of the concentration of lactate in the serum subsequent to the Fontan procedure in small children. Cardiol Young 2006; 16: 275–280.Google Scholar
20. Ikai, A, Fujimoto, Y, Hirose, K, et al. Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms. J Thorac Cardiovasc Surg 2008; 135: 1145–1152.Google Scholar
21. Shikata, F, Yagihara, T, Kagisaki, K, et al. Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Eur J Cardiothorac Surg 2008; 34: 570–575.Google Scholar
22. Mastropietro, CW, Clark, JA, Grimaldi, L, Killinger, J, Ricmond, M. The infant with a single cardiac ventricle. Curr Pediat Rev 2012; 8: 253–276.Google Scholar
23. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.Google Scholar
24. Schwartz, GJ, Haycock, GB, Edelmann, CM Jr, Spitzer, A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976; 58: 259–263.Google Scholar
25. Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.Google Scholar
26. Morales, DL, Carberry, KE, Heinle, JS, McKenzie, ED, Fraser, CD Jr, Diaz, LK. Extubation in the operating room after Fontan's procedure: effect on practice and outcomes. Ann Thorac Surg 2008; 86: 576–581.Google Scholar