Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease

Heather K Chandler, Roxanne Kirsch, Heather K Chandler, Roxanne Kirsch

Abstract

The purpose of this review is to discuss the management of the low cardiac output syndrome (LCOS) following surgery for congenital heart disease. The LCOS is a well-recognized, frequent post-operative complication with an accepted collection of hemodynamic and physiologic aberrations. Approximately 25% of children experience a decrease in cardiac index of less than 2 L/min/m2 within 6-18 hours after cardiac surgery. Post-operative strategies that may be used to manage patients as risk for or in a state of low cardiac output include the use of hemodynamic monitoring, enabling a timely and accurate assessment of cardiovascular function and tissue oxygenation; optimization of ventricular loading conditions; the judicious use of inotropic agents; an appreciation of and the utilization of positive pressure ventilation for circulatory support; and, in some circumstances, mechanical circulatory support. All interventions and strategies should culminate in improving the relationship between oxygen supply and demand, ensuring adequate tissue oxygenation.

Figures

Fig. (1)
Fig. (1)
Scatterplots showing serial measurements of cardiac index (top) as determined by thermodilution techniques and inotropic support (bottom) in 122 patients after the arterial switch operation for transposition of the great arteries. Cardiac index fell during the first postoperative night, returning to baseline values by 24 hours after surgery. TGA/IVA, transposition of the great arteries with intact ventricular septum; TGA/VSD, TGA with a ventricular septal defect; DHCA, deep hypothermic circulatory arrest; Wernovsky G et al. Circulation 1995; 92: 2226-35. [used with permission].

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