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Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery.
Kim, Michael E; Baskar, Shankar; Janson, Christopher M; Chandler, Stephanie F; Whitehill, Robert D; Dionne, Audrey; Law, Mark A; Domnina, Yuliya; Smith-Parrish, Melissa N; Bird, Geoffrey L; Banerjee, Mousumi; Zhang, Wenying; Reichle, Garrett; Schumacher, Kurt R; Czosek, Richard J; Morales, David L S; Alten, Jeffrey A.
Afiliación
  • Kim ME; Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: michaele.kim@sickkids.ca.
  • Baskar S; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Janson CM; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • Chandler SF; Department of Cardiology, Lurie Children's Hospital, Chicago, Illinois.
  • Whitehill RD; Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia.
  • Dionne A; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
  • Law MA; Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.
  • Domnina Y; Department of Cardiac Critical Care, Children's National Hospital, Washington, DC.
  • Smith-Parrish MN; Department of Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee.
  • Bird GL; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • Banerjee M; Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan.
  • Zhang W; Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan.
  • Reichle G; Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan.
  • Schumacher KR; Department of Cardiology, C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan.
  • Czosek RJ; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Morales DLS; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Alten JA; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Ann Thorac Surg ; 117(6): 1178-1185, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38484909
ABSTRACT

BACKGROUND:

Junctional ectopic tachycardia (JET) complicates congenital heart surgery in 2% to 8.3% of cases. JET is associated with postoperative morbidity in single-center studies. We used the Pediatric Cardiac Critical Care Consortium data registry to provide a multicenter epidemiologic description of treated JET.

METHODS:

This is a retrospective study (February 2019-August 2022) of patients with treated JET. Inclusion criteria were (1) <12 months old at the index operation, and (2) treated for JET <72 hours after surgery. Diagnosis was defined by receiving treatment (pacing, cooling, and medications). A multilevel logistic regression analysis with hospital random effect identified JET risk factors. Impact of JET on outcomes was estimated by margins/attributable risk analysis using previous risk-adjustment models.

RESULTS:

Among 24,073 patients from 63 centers, 1436 (6.0%) were treated for JET with significant center variability (0% to 17.9%). Median time to onset was 3.4 hours, with 34% present on admission. Median duration was 2 days (interquartile range, 1-4 days). Tetralogy of Fallot, atrioventricular canal, and ventricular septal defect repair represented >50% of JET. Patient characteristics independently associated with JET included neonatal age, Asian race, cardiopulmonary bypass time, open sternum, and early postoperative inotropic agents. JET was associated with increased risk-adjusted durations of mechanical ventilation (incidence rate ratio, 1.6; 95% CI, 1.5-1.7) and intensive care unit length of stay (incidence rate ratio, 1.3; 95% CI, 1.2-1.3), but not mortality.

CONCLUSIONS:

JET is treated in 6% of patients with substantial center variability. JET contributes to increased use of postoperative resources. High center variability warrants further study to identify potential modifiable factors that could serve as targets for improvement efforts to ameliorate deleterious outcomes.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Taquicardia Ectópica de Unión / Cardiopatías Congénitas / Procedimientos Quirúrgicos Cardíacos País/Región como asunto: America do norte Idioma: En Revista: Ann Thorac Surg Año: 2024 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Taquicardia Ectópica de Unión / Cardiopatías Congénitas / Procedimientos Quirúrgicos Cardíacos País/Región como asunto: America do norte Idioma: En Revista: Ann Thorac Surg Año: 2024 Tipo del documento: Article