Beschreibung:
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<jats:title>Objectives:</jats:title>
<jats:p>Ventricular-arterial coupling represents the interaction between the left ventricle and the arterial system. Ventricular-arterial coupling is measured as the ratio between arterial elastance and ventricular end-systolic elastance. Scant information is available in critically ill children about these variables. The aim of this study was to prospectively assess ventricular-arterial coupling after pediatric cardiac surgery and evaluate its association with other commonly recorded hemodynamic parameters.</jats:p>
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<jats:title>Design:</jats:title>
<jats:p>Single-center retrospective observational study.</jats:p>
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<jats:title>Setting:</jats:title>
<jats:p>Pediatric cardiac surgery operating room.</jats:p>
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<jats:title>Patients:</jats:title>
<jats:p>Children undergoing corrective cardiac surgery.</jats:p>
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<jats:title>Interventions:</jats:title>
<jats:p>Hemodynamic monitoring with transesophageal echocardiography.</jats:p>
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<jats:title>Measurements and Main Results:</jats:title>
<jats:p>Twenty-seven patients with biventricular congenital heart disease, who underwent elective cardiac surgery with cardiopulmonary bypass, were enrolled before operating room discharge. Chen single-beat modified method was applied to calculate ventricular-arterial coupling. The median arterial elastance and end-systolic elastance values were 5.9 mm Hg/mL (2.2–9.3 mm Hg/mL) and 4.3 mm Hg/mL (1.9–8.3 mm Hg/mL), respectively. The median ventricular- arterial coupling was 1.2 (1.1–1.6). End-systolic elastance differences between patients with a ventricular-arterial coupling below (low ventricular-arterial coupling) and above (high ventricular-arterial coupling) the median value were –5.2 (95% CI, –6.28 to –0.7; <jats:italic toggle="yes">p</jats:italic> = 0.008). Differently, arterial elastance differences were –2.1 (95% CI, –5.7 to 1.6; <jats:italic toggle="yes">p</jats:italic> = 0.19). Ventricular-arterial coupling showed a significant association with pre-ejection time (<jats:italic toggle="yes">r</jats:italic>, 0.44; <jats:italic toggle="yes">p</jats:italic> = 0.02), total ejection time (<jats:italic toggle="yes">r</jats:italic>, –0.41; <jats:italic toggle="yes">p</jats:italic> = 0.003), cardiac cycle efficiency (<jats:italic toggle="yes">r</jats:italic>, –0.46; <jats:italic toggle="yes">p</jats:italic> = 0.02), maximal delta pressure over delta time (<jats:italic toggle="yes">r</jats:italic>, –0.44; <jats:italic toggle="yes">p</jats:italic> = 0.02), ejection fraction (<jats:italic toggle="yes">r</jats:italic>, –0.57; <jats:italic toggle="yes">p</jats:italic> = 0.01), and systemic vascular resistances indexed (0.56; <jats:italic toggle="yes">p</jats:italic> = 0.003). After adjustment, total ejection time (<jats:italic toggle="yes">p</jats:italic> = 0.001), pre-ejection time (<jats:italic toggle="yes">p</jats:italic> = 0.02), and ejection fraction (<jats:italic toggle="yes">p</jats:italic> = 0.001) remained independently associated with ventricular-arterial coupling.</jats:p>
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<jats:title>Conclusions:</jats:title>
<jats:p>Median ventricular-arterial coupling values in children after cardiac surgery appear high (above 1). Uncoupling was particularly evident in high ventricular-arterial coupling patients who showed the lowest end-systolic elastance values (but not significantly different arterial elastance values) compared with low ventricular-arterial coupling. Ventricular-arterial coupling appears to be inversely proportional to pre-ejection time, total ejection time, and ejection fraction.</jats:p>
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