Évaluation du débit cardiaque après ralentissement de la fréquence cardiaque par un inhibiteur des canaux de l’If en postopératoire précoce de cardiopathies congénitales sous inotropes

Abstract : Background: low cardiac output syndrome (LCOS) is common after pediatric cardiac surgery (PCS). Catecholamines represent the first-line treatment considering their positive inotropic and chronotropic effects. However after PCS, other triggers will be responsible for sinus tachycardia. Conventionally, it is accepted that infants adapt their cardiac output (CO) by increasing heart rate (HR). The objective of this study was to evaluate the ability of ivabradine to decrease sinus tachycardia and its consequences on CO in infants after PCS. Methods: in a prospective, single-center, open-label pilot study, we included patients aged 0 to 18 years who presented an LCOS requiring catecholamine and developed a sinus tachycardia (greater than 90th percentile for age) despite hemodynamic optimization. Patients were included within 3 to 72 hours of a PCS requiring cardiopulmonary bypass (CPB) and aortic cross-clamp. The primary endpoint was to evaluate the CO after decrease at least 10% of HR with ivabradine compared to baseline HR (H0). The secondary endpoints were to evaluate after decrease HR the changes on tissue perfusion (at 6th hour (H6)). Adverse events were monitored. Results: twenty-two patients were included. Median age of the sample was 3 [1-6] months. Six hours after administration of ivabradine, HR was reduced by 12,6%. Between H0 and H6, HR decreased from 169.8 [155.2-179.7] to 148.9 [130.3-155.7] beats per minute (P <0.0001). Over time, mixed venous saturation (SvO2) remained stable (67.9 [59-77.9] to 67.4 [64.54-77.8] %, P =0.71) while left ventricular velocity-time integral increased (7 [5,5-12] to 11 [7,2-13,1] cm, P <0.05). Only one adverse event was noted (i.e. sinus bradycardia). Conclusion: our findings suggest that the use of ivabradine after PCS in infants who received inotropic support, improved hemodynamics parameters and tissue perfusion despite significant decrease HR.
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Yaël Levy. Évaluation du débit cardiaque après ralentissement de la fréquence cardiaque par un inhibiteur des canaux de l’If en postopératoire précoce de cardiopathies congénitales sous inotropes. Médecine humaine et pathologie. 2018. ⟨dumas-02077347⟩

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