Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

Nowadays, the vast majority of patients born with congenital heart disease are expected to survive reaching adulthood.
Physical activity is a very important part of the life of all children and adolescents, and to renounce it is to renounce part of the beauty of the life.

However, overprotection from parents, guardians and teachers, an objectively impaired exercising capacity in comparison to peers, and uncertainty about which physical activities are recommended and with what intensity, all contribute to pushing congenital heart patients towards a sedentary life stile.

How to encourage a safe physical activity in this group of children and adolescents?

Knowledge of the anatomy, either natural or postsurgical, and physiology of the different congenital heart diseases is a prerequisite for the selection of type and extent of sport activity, as well as for the selection of the most suitable testing method to evaluate sport eligibility.
In the literature, reference values for exercise limitations among patients with CHD have been published. However, it is important to understand the significance of the different parameters.

An accurate evaluation of the child history, physical examination, echocardiographic or other imaging evaluation, Holter monitoring to discover rest or exercise arrhythmia, are the first step. Cardiopulmonary step test (CPET) with ECG monitoring and expiratory gas analysis allows to obtain objective parameters such as pick VO2, Max Heart rate and pressure, O2 pulse, VE/VCO2 slope, exercise induced arrhythmia. These objective parameters must be associated to the Borg scale, which estimates the rate of perceived exertion. The significance of these parameters in the various congenital heart diseases, in natural history and post surgery, will be presented in the slides.

Since 2005, data on the usefulness of exercise training to improve the cardiovascular fitness in congenital heart patients, in paediatric and adult age has been published in the literature. A selection of this data will be shown and complete the presentation.

Abstract Body

Acute kidney injury (AKI) after cardiac surgery in children with congenital heart disease is a serious complication associated with high morbidity and mortality. We evaluated the incidence, risk factors and postoperative outcome of AKI in children following arterial switch operation (ASO).

DESIGN: Single-center retrospective chart review. Inclusion; all children with transposition of the great arteries (TGA) undergoing ASO in our tertiary children’s hospital between 2000-2019. Severe AKI was defined as 100% serum creatinine rise over baseline. Highest lactate was noted during the operation date. Logistic regression was used to adjust for confounders.

RESULTS: ASO was performed on 242 children. Overall mortality was 3.3%. Of the 242 children, 24% developed severe AKI. 4 children (7%) were treated with renal replacement therapy. Higher plasma lactate (p=0,012) is an independent risk factor for developing AKI. Children with severe AKI had a longer ventilation duration (p=0.000), a longer PICU stay (p=0.001), a higher rate of infarction (p=0,001), sepsis (p=0.002), pulmonary hypertension (p=0.002) and a higher mortality rate (10% vs 1%, p=0.000). Lactate>4 mmol/l is an independent predictor for AKI (OR 2.9, p= 0.001).

CONCLUSIONS:

A quarter of the children develop severe AKI after ASO. (Peri)operative lactate was a significant independent predictor for developing severe AKI. Awareness of the high incidence of AKI is important in order to monitor these children more closely, be more fluid restrictive and avoid nephrotoxic drugs.

Abstract Body

Background and aim

Beside comfort care, staged surgical palliation may be proposed for hypoplastic left heart syndrome (HLHS) and related defects with functional single ventricle and systemic outflow tract obstruction. The parental choice may be challenging due to persistent mortality and uncertain outcomes after surgery. This study reported the evolution of care and survival after first-stage palliation in a Belgian tertiary center.

Methods

This was a retrospective cohort analysis of neonates born with HLHS or HLHS-related anomalies between 2003 and 2018. Demographics, type of care, perioperative variables and outcomes after first-stage palliation were collected.

Results

Comfort care, which was provided to 14 out of 52 neonates (27%), declined over time to the benefit of surgery (P=.03). Three neonates with HLHS (5.7%) died preoperatively. Thirty-five neonates with HLHS (n=25, 71.4%) and HLHS-related anomalies (n=10, 28.6%) were operated. Thirty-day postoperative survival was 62.8%. Survival before Glenn procedure was 48.6%. Mortality rates were unchanged over time. Univariate analyses of factors influencing survival revealed that cardiopulmonary bypass and aortic clamp times were lower in surviving patients with HLHS (P=.02 and P=.04 respectively). NIRS monitoring led to an increase in preoperative intubation (P=.03). This was not associated with increased mortality. Other factors, including the type of surgery and cardiac anatomy, did not significantly affect survival.

Conclusion

Consistent with the rarity of HLHS, our center exhibited limited case volume and slightly higher mortality than high-volume centers. Regionalization of Belgian cardiac surgery centers with standardized protocol might be crucial to increase hospital volume and improve survival.

Abstract Body

Background/Aim: In adulthood, the lactate kinetics have been associated with critically ill patients’ outcome. Aim: test the lactate kinetics as a short-term risk stratification method in critically ill children admitted to a pediatric intensive care unit (PICU).

Methods: Exploratory study with retrospective data collection of patients admitted to PICU from 2016-2019. The difference between the maximum lactate concentration in Day1 (D1) and in Day2 (D2) was used to calculate delta-lactate (ΔL). According to ΔL cut-off (0.05mmol/L), two groups were considered: low mortality risk (LMR) and high mortality risk (HMR).

Results: The study included 249 patients, with a median age of 5.6 years old [0.9-13.7], 60.6% were males. The most frequent diagnosis on admission was respiratory disorders (33.7%), trauma (15.7%) and shock (15.3%). 8.0% of the patients died. Elevated lactate in D1 (survivors: 1.5mmol/L vs non-survivors: 3.0mmol/L, p=0.006) and in D2 (survivors: 1.1mmol/L vs non-survivors: 2.4mmol/L, p<0.001) were associated with mortality during PICU stay. Considering maximum lactate in D1 ≥2.0 mmol/L (n=93), the area under the ROC curve was 0.698 [CI95% 0.47-0.93], for a ΔL’s cut-off value 0.05 mmol/L. HMR patients had a significant median higher lactate levels in D2 (5.6 vs 1.6, p<0.001), fewer ventilation-free-days (0 vs 21, p=0.011) and needed renal replacement therapy more often (31.3% vs 7.8%, p=0.020) than LMR patients.

Conclusion: Higher lactate levels, both in D1 and in D2 proved to be related to mortality. A cut-off value for ΔL 0.05mmol/L seems to be a good predictor of mortality in this sample.

Abstract Body

Objective

To compare ‘Balanced Crystalloids’ with ‘Normal Saline’ as initial fluid for resuscitation in children with septic shock with respect to acute kidney injury (AKI) in the first 7 days.

Methods

Children <17 years’ age with septic shock were randomized to receive boluses of either Balanced Crystalloids (Plasma-Lyte A; ‘BC group’) or Normal Saline (‘NS group’) for initial resuscitation at 4 study sites from 2017 to 2019. All children were managed as per the Surviving Sepsis Campaign Guidelines 2017 and were monitored till discharge/death. AKI was defined as per 2012 KDIGO clinical practice guidelines. Primary outcome was the risk of AKI in the first 7 days after initial fluid resuscitation. Other important outcomes were requirement of renal replacement therapy (RRT), risk of hyperchloremia and mortality.

Results

We enrolled 708 children: 351 and 357 in the ‘BC’ and ‘NS’ groups, respectively. Baseline characteristics were comparable. The fluid volumes received in the first 24 hours were similar in both groups. There was a significant reduction in the risk of AKI (20% vs. 33%; RR: 0.62; 95% CI 0.48 to 0.80; p=0.0001) and requirement of RRT (10% vs. 20%; RR 0.50; 0.34 to 0.73; p=0.0002) in the ‘BC group’. The risk of hyperchloremia at 72 hours was also lower in the ‘BC group’ (Table 1). The mortality in both groups was however, similar (33% vs. 34%; RR 0.96; 0.78 to 1.19).

Conclusions

Use of Balanced Crystalloids as resuscitation fluid in children with septic shock was associated with reduced risk of acute kidney injury.