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. 2019 Feb;40(2):366-373.
doi: 10.1007/s00246-018-2018-1. Epub 2018 Nov 9.

The Relationship Between Pre-operative Left Ventricular Longitudinal Strain and Post-operative Length of Stay in Patients Undergoing Arterial Switch Operation Is Age Dependent

Scott A Pletzer  1 , Andrew M Atz  2 , Shahryar M Chowdhury  2
Affiliations

The Relationship Between Pre-operative Left Ventricular Longitudinal Strain and Post-operative Length of Stay in Patients Undergoing Arterial Switch Operation Is Age Dependent

Scott A Pletzer et al. Pediatr Cardiol. 2019 Feb.

Abstract

Introduction: Post-operative length of stay (LOS) after the arterial switch operation (ASO) is variable. The association between pre-operative non-invasive measures of ventricular function and post-operative course has not been well established. The aims of this study were to (1) evaluate the relationship between pre-operative non-invasive measures of ventricular function and post-operative LOS and (2) evaluate the change in ventricular function after ASO.

Methods: Data were reviewed in consecutive ASO patients between 2010 and 2016. The primary outcome was post-operative LOS. Echocardiograms obtained during the pre-operative period and at the time of discharge were retrospectively analyzed using speckle-tracking echocardiography. Pearson's correlation between patient-specific, pre-operative, and echocardiographic data versus post-operative LOS was assessed.

Results: Fifty-two patients were included in analyses, 39 neonates and 13 infants. Left ventricular (LV) longitudinal strain correlated with post-operative LOS for infants age > 28 days (r = 0.62, p = 0.03), but not for neonates (r = 0.14, p = 0.40). Operative age (r = - 0.42, p = 0.003), weight at surgery (r = - 0.48, p ≤ 0.001), and cardiopulmonary bypass time (r = 0.30, p = 0.045) also correlated with post-operative LOS. Standard 2D measures of ventricular function did not correlate with post-operative LOS. LV ejection fraction and longitudinal strain worsened post-operatively.

Conclusion: Higher pre-operative LV longitudinal strain (representing worse LV function) is associated with increased post-operative LOS after ASO in infants > 28 days, but not in neonates. LV ejection fraction and longitudinal strain worsened after ASO. Future studies should assess the utility of performing STE in risk stratifying patients prior to ASO.

Keywords: Congenital heart disease; Neonatal surgery; Speckle-tracking echocardiography; Transposition of the great arteries.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Representation of STE with corresponding deformation curves: a analysis of LV longitudinal strain from apical four chamber view; b analysis of RV longitudinal strain from apical four chamber view; c analysis of LV circumferential strain from parasternal short-axis view
Fig. 2
Fig. 2
Neonates Pre-operative LV longitudinal strain on x-axis (more negative indicates better ventricular function), post-operative LOS on y-axis
Fig. 3
Fig. 3
Infants Pre-operative LV longitudinal strain on x-axis (more negative indicates better ventricular function), post-operative LOS on y-axis
See this image and copyright information in PMC

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