title: The effect of intraoperative hypotension on the outcomes of initial hybrid palliation for single ventricle congenital heart disease: an historical cohort study.
abstract: BACKGROUND
  The "hybrid procedure" is an alternative surgical palliation strategy for single ventricle congenital heart disease. The purported benefit is improved cognitive ability secondary to avoidance of cardiopulmonary bypass in the neonatal period when neuronal apoptosis is greater. It is unknown whether survival is improved after this procedure. Intraoperative hypotension is common in these patients, and we hypothesized that this hypotension was associated with mortality or morbidity.
  
  
  METHODS
  We reviewed the records of 58/58 patients undergoing a first-stage hybrid procedure from 2004 to 2010 in a tertiary pediatric academic centre. Risk factors for poor outcome and the association between intraoperative hypotension and morbidity or mortality were investigated.
  
  
  RESULTS
  Average preoperative arterial blood pressure (ABP) [systolic/diastolic presented as mean (standard deviation)] were 68 (12.7) / 38 (9.4) mmHg. Post-induction ABP was 65 (15.2) / 37 (8.6) mmHg. The average intraoperative nadir of ABP was 45 (7.0) / 26 (4.8) mmHg. On return to the intensive care unit (ICU), the average ABP was 69 (13.7) / 38 (11.6) mmHg. The nadir lasted longer than ten minutes in 32/58 patients. The mortality at 48 hr, 60 days, and 12 months was 3/58 (5%), 10/58 (17%), and 15/58 (26%), respectively. Six patients returned to the ICU on extracorporeal membrane oxygenation (ECMO). There was a weak statistical correlation between the average mean and diastolic BP pre-induction and changes of > 20% in systolic and diastolic BP during the case.
  
  
  CONCLUSIONS
  In this patient cohort, we can show an association between short periods of intraoperative hypotension and mortality or return to the ICU on ECMO, but the importance of this is not certain.
authors: Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada.
authors: James
authors: J
authors: Koziol
authors: Ralph
authors: R
authors: Gertler
authors: Cedric
authors: C
authors: Manlhiot
authors: Brian
authors: B
authors: McCrindle
authors: Helen
authors: H
authors: Holtby
authors: Christopher A
authors: CA
authors: Caldarone
authors: Katherine
authors: K
authors: Taylor
mesh_terms: D000046:Academic Medical Centers; D001794:Blood Pressure; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007431:Intraoperative Complications; D008297:Male; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome