Ventricular-Arterial Coupling in Children and Infants With Congenital Heart Disease After Cardiopulmonary Bypass Surgery
Observational Study
Marinari, Eleonora, MD1; Rizza, Alessandra, MD1; Iacobelli, Roberta, MD2; Iodice, Francesca, MD1; Favia, Isabella, MD1; Romagnoli, Stefano, MD3; Di Chiara, Luca, MD1; Ricci, Zaccaria, MD1

Pediatric Critical Care Medicine: June 4, 2019 - Volume Online First - Issue - p
doi: 10.1097/PCC.0000000000001982
Cardiac Intensive Care: PDF Only
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Objectives: 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.

Design: Single-center retrospective observational study.

Setting: Pediatric cardiac surgery operating room.

Patients: Children undergoing corrective cardiac surgery.

Interventions: Hemodynamic monitoring with transesophageal echocardiography.

Measurements and Main Results: 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; p = 0.008). Differently, arterial elastance differences were –2.1 (95% CI, –5.7 to 1.6; p = 0.19). Ventricular-arterial coupling showed a significant association with pre-ejection time (r, 0.44; p = 0.02), total ejection time (r, –0.41; p = 0.003), cardiac cycle efficiency (r, –0.46; p = 0.02), maximal delta pressure over delta time (r, –0.44; p = 0.02), ejection fraction (r, –0.57; p = 0.01), and systemic vascular resistances indexed (0.56; p = 0.003). After adjustment, total ejection time (p = 0.001), pre-ejection time (p = 0.02), and ejection fraction (p = 0.001) remained independently associated with ventricular-arterial coupling.

Conclusions: 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.

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies