Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome

J Matern Fetal Neonatal Med. 2012 Dec;25(12):2756-61. doi: 10.3109/14767058.2012.718393. Epub 2012 Sep 7.

Abstract

Background: Low cardiac output syndrome (LCOS) remains a major perioperative complications in infants subjected to open-heart surgery with cardiopulmonary bypass (CPB). The present study investigated whether perioperative blood assessment of a potent vasoactive peptide namely adrenomedullin (AM) can predict the risk of LCOS.

Methods: We measured AM levels in 48 patients (LCOS: n = 9; controls: n = 39) undergone to open-heart surgery with CPB at five predetermined time points before, during and after the surgery. Clinical, laboratory and perioperative data were analyzed by a multiple logistic regression model.

Results: AM significantly decreased (p < 0.01) during and after the surgical procedure exhibiting a dip at the end of the CPB. Multivariable analysis demonstrated significant correlations among LCOS, AM measured at the end of CPB (p < 0.001), and cooling duration (p < 0.05). AM at 27 pg/L cutoff achieved a sensitivity of 100% and a specificity of 64.1%, while cooling at 11-min cutoff combined a sensitivity of 55.6% and a specificity of 92.3% for LCOS prediction.

Conclusions: This study suggests that AM can constitute, alone or combined with standard parameters, a promising predictor of LCOS in infants subjected to open-heart surgery with CPB.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenomedullin / analysis
  • Adrenomedullin / blood*
  • Age Factors
  • Cardiac Output, Low / blood*
  • Cardiac Output, Low / diagnosis*
  • Cardiac Output, Low / epidemiology
  • Cardiac Output, Low / etiology*
  • Cardiopulmonary Bypass / adverse effects*
  • Cardiopulmonary Bypass / statistics & numerical data
  • Case-Control Studies
  • Female
  • Heart Defects, Congenital / blood
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / epidemiology
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Postoperative Complications / blood
  • Postoperative Complications / congenital
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Prognosis
  • Sensitivity and Specificity

Substances

  • Adrenomedullin