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PERI-OPERATIVE INHALED NITRIC OXIDE USE PREDICTS INCREASED MORTALITY FOLLOWING ARTERIAL SWITCH OPERATION
Muhammad Faateh, MBBS, Muhammad A. Raees, MD, Hosam F. Ahmed, MD, PhD, James F. Cnota, MD, David S. Cooper, MD, Micheal Gaies, MD, MS, Marco Ricci, MD, MBA, David G. Lehenbauer, MD, David Morales, MD, Awais Ashfaq, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objective:The role of peri-operative inhaled-nitric-oxide(iNO) on outcomes following arterial-switch-operation(ASO) has not been studied well.
Methods:Neonates with d-transposition of great arteries+intact ventricular septum undergoing ASO were identified from the Pediatric-Health-Information-System-Database. Outcomes were compared by dividing patients into the following groups: never-iNO use, iNO initiated preop-iNO, day-of-ASO and post-op-day(POD) ≥1. A sub-analysis was performed in iNO-preop group comparing if iNO was weaned-off preop(≥24h) vs not.
Results:A total of 3,303 patients were identified of which 835(25.3%) had iNO use. iNO groups were more likely to be preterm(<37-weeks) and low-birthweight(<2.5kg), p<0.05. iNO was weaned-off in 70.7% patients pre-operatively. Use of iNO was associated with higher rates of mortality(any-iNO-use:3.1% vs never-iNO:0.8%, p<0.001). By groups:never-iNO:0.8%, iNO-pre-op:1.5%, iNO-day-of-ASO:3.9%, iNO-POD≥1: 9.7%, p<0.001). After adjusting for prematurity and birthweight, and other confounders, iNO remained as a significant predictor of the composite outcome(mortality/post-op ECMO/delayed sternum closure/post-op Dialysis)[OR(95%CI): iNO-preop:1.71(1.22-2.39), iNO-day-of-ASO:1.58(1.06-2.36), iNO-post-op:2.98(1.67-5.31), all p<0.05]. In the iNO-preop sub-analysis, iNO weaned within 24hrs post-op vs not had similar mortality and composite outcome(p>0.05).
Conclusions:Peri-operative iNO use quadruples mortality and is a strong predictor of adverse post-operative outcomes in neonates undergoing ASO. iNO may serve as surrogate marker of underlying lung immaturity and pulmonary hypertension in these patients.
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