Pulmonary Infections are Common in Patients with PAB in LV-DCM

Objectives: Left ventricular-dilated cardiomyopathy (LV-DCM) is a leading cause of cardiac death in children. Against the background of the diverse limitations of heart transplantation, the concept of pulmonary artery banding (PAB) in DCM has emerged as a new therapeutic method with promising results. But despite the relatively less-invasive character of the surgical procedure, the intensive care treatment in patients with multiple-organ dysfunction remains challenging. This analysis targets pulmonary infections that complicate postoperative course.

Methods: Patients who underwent PAB in DCM were analyzed for postoperative pulmonary complications. Primary outcome was time to extubation, secondary outcomes were need for noninvasive respiratory support, occurence of fever in the first 24 hours after surgery, appearance of trachel secretions, and the frequency of extended antibiotic treatment.

Result: Between 2006 and 2017 33, patients (mean age at procedure 330 ± 373 days) were treated with PAB in DCM. Average time on ventilator was 2 ± 2 days. After extubation 27 patients (81%) needed noninvasive respiratory support. In the first 24 hours after surgery, fever (>38°C) was detected in 14 patients (42%), and in 18 patients (55%), secretions from tracheal suctioning were described as yellowish. Twenty-three patients (70%) were treated with an extended antibiotic regimen because of markedly raised C-reactive (CRP) levels with clinical picture of pneumonia or even septic disease with pulmonary focus.

Conclusion: Pulmonary infections are common in patients with LV-DCM after PAB and complicate postoperative course. The perioperative antibiotic treatment should be adapted to this fact. Postoperative airway management should enable an optimal ventilation of congested lungs. Noninvasive respiratory support is of crucial importance in the postoperative therapy of patients with PAB in LV-DCM.