{"title":"Vasopressin as a postoperative management strategy in Fontan procedure: a comparative study.","authors":"Shubhadeep Das, Debasis Das, Nilanjan Dutta, Manish Kumar Sharma, Shivani Gajpal, Susovan Halder, Unmesh Chakraborty, Apu Saha, Bharath Saske, Shubham Gupta","doi":"10.1007/s12055-024-01873-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The Fontan procedure is crucial for managing univentricular heart conditions but can lead to prolonged pleural effusions, affecting recovery and hospital stays. This study evaluated the effectiveness of vasopressin in reducing pleural effusion and improving recovery outcomes following Fontan procedure.</p><p><strong>Methods: </strong>This comparative observational study reviewed patient records from October 2021 to September 2023. Two cohorts were included of 23 patients each: patients who received postoperative vasopressin from October 2022 to September 2023 (VP group) and a historical control group from the previous year (NVP group), excluding those who underwent fenestrated Fontan. Vasopressin was administered postoperatively to the VP group to mitigate pleural effusion. Primary outcomes were the volume and duration of chest tube drainage. Secondary outcomes included hospital and intensive care unit (ICU) stay durations and fluid balance metrics.</p><p><strong>Results: </strong>There were no significant differences in the primary or secondary outcomes between the vasopressin group and the control group. The median total drain outputs in the VP and NVP groups were 69.4 ml/kg and 53.9 ml/kg, respectively (<i>p</i> = 0.96). The median duration of chest tube stay was 5.5 days for the VP group and 6 days for the NVP group (<i>p</i> = 0.74). Hospital stay duration (<i>p</i> = 0.74) and ICU stay duration (<i>p</i> = 0.82) showed no significant difference.</p><p><strong>Conclusion: </strong>Vasopressin does not significantly impact chest tube drainage volume or duration, nor does it reduce hospital stays in Fontan patients, suggesting a limited role in managing postoperative pleural effusions. Further research is needed to explore its benefits for specific patient subgroups and acute hemodynamic instabilities postoperatively.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>Below is the link to the electronic supplementary material. 10.1007/s12055-024-01873-9.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 4","pages":"395-403"},"PeriodicalIF":0.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933559/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-024-01873-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/28 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The Fontan procedure is crucial for managing univentricular heart conditions but can lead to prolonged pleural effusions, affecting recovery and hospital stays. This study evaluated the effectiveness of vasopressin in reducing pleural effusion and improving recovery outcomes following Fontan procedure.
Methods: This comparative observational study reviewed patient records from October 2021 to September 2023. Two cohorts were included of 23 patients each: patients who received postoperative vasopressin from October 2022 to September 2023 (VP group) and a historical control group from the previous year (NVP group), excluding those who underwent fenestrated Fontan. Vasopressin was administered postoperatively to the VP group to mitigate pleural effusion. Primary outcomes were the volume and duration of chest tube drainage. Secondary outcomes included hospital and intensive care unit (ICU) stay durations and fluid balance metrics.
Results: There were no significant differences in the primary or secondary outcomes between the vasopressin group and the control group. The median total drain outputs in the VP and NVP groups were 69.4 ml/kg and 53.9 ml/kg, respectively (p = 0.96). The median duration of chest tube stay was 5.5 days for the VP group and 6 days for the NVP group (p = 0.74). Hospital stay duration (p = 0.74) and ICU stay duration (p = 0.82) showed no significant difference.
Conclusion: Vasopressin does not significantly impact chest tube drainage volume or duration, nor does it reduce hospital stays in Fontan patients, suggesting a limited role in managing postoperative pleural effusions. Further research is needed to explore its benefits for specific patient subgroups and acute hemodynamic instabilities postoperatively.
Graphical abstract:
Supplementary information: Below is the link to the electronic supplementary material. 10.1007/s12055-024-01873-9.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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