The role of intraoperative pulmonary artery pressure monitoring in the postoperative management of infants with ventricular septal defect and pulmonary hypertension

Abstract

Abstract Background The fast-track approach in pediatric cardiac surgery shortens hospital stays and reduces medical costs. This study aims to evaluate the feasibility of the fast-track approach and the role of intraoperative pulmonary artery pressure (PAP) monitoring in managing patients with preoperative pulmonary hypertension (PH) who underwent ventricular septal defect (VSD) closure. Methods This retrospective study included 94 infants with VSD and preoperative PH. Intraoperative systolic PAP monitoring was performed to evaluate the suitability of the fast-track approach (< 35 mmHg). Postoperative adverse events included in-hospital death, PH crisis and prolonged mechanical ventilation time, and nitric oxide (NO) administration. Results The fast-track approach was carried out in 35 patients (37%). One in-hospital death (1%) occurred in a non-fast-track patient due to postoperative PH crisis. Two patients (5.7%) required re-intubation after the fast-track approach due to upper airway issues. The frequency of NO inhalation and administration of pulmonary hypertensive medicines was significantly lower in the fast-track group than in the non-fast-track group (P < 0.001). Multivariate analysis revealed that body weight of < 4 kg at surgery was (P = 0.006), surgery by trainees (P = 0.002), and greater intraoperative systolic PAP (P < 0.001) were significant risk factors for postoperative adverse events. Conclusions Our findings showed that the fast-track approach after VSD closure in infants with preoperative PH was feasible as indicated by the low frequency of re-intubation and postoperative adverse events. Intraoperative systolic PAP measurement was useful for selecting patient to be included in the fast-track approach.