Is Mechanical Ventilation Mandatory After Surgery for Congenital Heart Disease?

Objectives: A fast track extubation protocol was introduced for patients with biventricular circulation and expected hemodynamic stability, and for patients after cavopulmonary anastomosis. Feasibility and risks of failing fast track are reported.

Methods: Retrospective analysis of 290 consecutive patients aged ≥28 days, who underwent operations for repair of ASD, partial AVSD, small VSD, partial anomalous pulmonary vein connections, and pulmonary and aortic valve surgery, n= 193, group 1, and for cavopulmonary anastomosis (BCPC, TCPC), n= 97, group 2. Patients were intentionally treated to be extubated in OR or latest 4 hours thereafter. Rate of early extubation was calculated. For patients, who were not extubated early, a multivariate regression analysis to describe risk factors was done.

Results: There was no difference between groups regarding ventilation time in ICU or missed early extubation (23 ± 70.5 min vs. 22.8 ± 75.2 min, p= 0.9, and 37.2 vs. 35.7%, p= 0.8, respectively). Two patients of group 2 had to be reintubated. Arrhythmia (HR: 2, 95% CI: 1.3 – 3.0, p= 0.001), postoperative infectious disease (HR: 2.8, 95% CI: 1.7 – 4.5, p < 0.0001), and impaired systolic ventricular function (HR: 2.2, 95% CI: 1.1 – 4.5, p= 0.02) were independent predictors for longer ventilation times after multivariate regression analysis.

Conclusions: In selected patients, early extubation was feasible and safe in two-thirds of cases. Arrhythmias, infections, and impaired cardiac function require longer ventilation times.