Imperial College London
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Professor Konstantinos Dimopoulos

Faculty of Medicine, National Heart & Lung Institute

Professor of Practice (Adult Congenital Heart Disease)
 
 
 
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Contact

 

+44 (0)20 7352 8121 ext 82771k.dimopoulos02

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bianchi:2021:10.1161/JAHA.120.020201,
author = {Bianchi, P and Constantine, A and Costola, G and Mele, S and Shore, D and Dimopoulos, K and Aw, T-C},
doi = {10.1161/JAHA.120.020201},
journal = {Journal of the American Heart Association},
title = {Ultra fast track extubation in adult congenital heart surgery},
url = {http://dx.doi.org/10.1161/JAHA.120.020201},
volume = {10},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background:In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to “ultrafasttrack” anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery.Methods And Results:Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactiveinotropic score 0.5 [0.0–2.0] versus 2.0 [0.0–3.5]; P<0.0001) and had a lower total net fluid balance than patients after conventional extubation (1168±723 versus 847±733 mL; P=0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a “stepdown” to wardbased care (48 [45–50] versus 50 [47–69] hours; P=0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430–4222] versus £4166 [3893–5603]; P<0.0001).Conclusions:In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower healthcarerelated costs.
AU  - Bianchi,P
AU  - Constantine,A
AU  - Costola,G
AU  - Mele,S
AU  - Shore,D
AU  - Dimopoulos,K
AU  - Aw,T-C
DO  - 10.1161/JAHA.120.020201
PY  - 2021///
SN  - 2047-9980
TI  - Ultra fast track extubation in adult congenital heart surgery
T2  - Journal of the American Heart Association
UR  - http://dx.doi.org/10.1161/JAHA.120.020201
UR  - http://hdl.handle.net/10044/1/89435
VL  - 10
ER  -
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