CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
28
AFRICA
tiser, has shown its superiority in various clinical trials conducted in
adult cardiac surgery. However its efficacy and safety in prevention
of treatment of LCOS in children undergoing surgery for congenital
heart disease has not been extensively studied.
Aim:
In children under two years of age after corrective open-heart
surgery for congenital heart disease to compare (1) the efficacy of
livosemendan to milrinone for prevention and treatment of low-
cardiac output state; and (2) the safety of livosemendan against that
of milrinone.
Methods:
This was a case–control study in which livosemendan was
used in place of milrinone in children undergoing total correction for
congenital heart disease. Both drugs were used prophylactically while
coming off bypass, with other ionotropes as deemed necessary. The
babies were monitored in the paediatric cardiac ICU over the next 72
hours for evidence of low-cardiac output state, in the form of heart
rate, blood pressure, urine output, serum lactate levels, vasotropic
ionotropic score, and ventricular function by echocardiography.
Results:
The groups did not differ significantly in the development
of LCOS and its recovery in the 72 hours. There were no serious
adverse events or unexpected adverse drug reactions during the study.
Conclusion:
Livosemendan is as safe and effective as milrinone in
the prevention and treatment of LCOS in children undergoing total
correction for congenital heart disease
645: EARLY AND INTERMEDIATE-TERM OUTCOMES
AFTER TRANSPLANTATION FOR RESTRICTIVE CARDIO-
MYOPATHY IN CHILDREN
Elfriede Pahl
1
, Philip Thrush
1
, Steven Kindel
1
, Katheryn Gambetta
1
,
Jeffrey Gossett
1
, John M. Costello
1
, Hyde Russell
2
, Carl L Backer
2
1
Lurie Children’s Hospital, Chicago, IL, USA
2
Northwestern Feinberg School of Medicine, Chicago, IL, USA
Background:
Restrictive cardiomyopathy (RCM) has the worst
outcome of all cardiomyopathies, with
>
50% mortality within
two years of diagnosis. Heart transplantation (Htx) in this patient
population has acceptable early mortality, however no studies of
intermediate-term outcomes exist. We hypothesised that RCM has
excellent early and mid-term survival.
Methods:
We reviewed our experience with paediatric Htx for RCM
from May 1988 to August 2012. Clinical data, support while waiting,
recipient and donor variables, and explant pathology were analysed.
Outcomes were examined via Kaplan–Meier survival curves.
Results:
Of 198 transplants in 189 patients during the study period,
17 (9%) had RCM. Median age at Htx was 7.7 (range 0.89–16.2)
years. Most common presentation was tachypnoea/cough (11), FTT
(three) and syncope (one). No patients had a dysmorphic syndrome;
however, one was diagnosed with a desmin cardiomyopathy and
another a mitochondrial disorder after Htx. Only two had familial
cardiomyopathy. Between listing and Htx, five patients were venti-
lated, and two were on mechanical support; 11 patients were status
1 or 1a. Median time from listing to Htx was 16 days (range 1–81).
Two had ABO-incompatible Htx at ages eight and 10 months. Thirty-
day, one-year and five-year survival were 100, 100 and 73%, respec-
tively, with seven deaths at 3.3 to 13.7 years post Htx. One patient
was retransplanted 8.9 years post Htx (CAV) and died four years
later of rejection. Other deaths were from rejection and/or sudden
death (four), rejection/infection (one), CAV (one) and PTLD (one).
Non-adherance was suspected in five of these patients.
Conclusions:
Heart transplant is an effective therapy for children
with RCM, providing excellent early and mid-term survival. Late
mortality was primarily due to rejection.
646: PREVALENCE, ASSOCIATED FACTORS AND
OUTCOMES OF ACUTE KIDNEY INJURY AMONG CHIL-
DREN AND ADOLESCENTS UNDERGOING CARDIOPUL-
MONARY BYPASS SURGERY IN NAIROBI, KENYA
Kaiser Fitzwanga
1
, Dalton Wamalwa
1
, Ruth Nduati
1
, Mark Gacii
1
,
Bashir Admani
1
, Doris Kinuthia
2
, John Ngigi
3
, Roseanne Nyabera
4
,
Benjamin Ngugi
5
, Christine Jowi
1
1
University of Nairobi, Nairobi, Kenya
2
The Aga Khan University Hospital, Nairobi, Kenya
3
Kenyatta National Hospital (KNH), Nairobi, Kenya
4
The Mater Hospital, Nairobi, Kenya
5
Kenya Medical Research Institute, Nairobi, Kenya
Background
: AKI is a serious complication associated with cardio-
pulmonary bypass surgery. The development of AKI is associated
with substantial morbidity and mortality. This study was done to
determine the prevalence and risk factors of AKI, and outcome
of children and adolescents with AKI following cardiopulmonary
bypass surgery at Kenyatta National and Mater Hospitals.
Methods
: This was a prospective cohort study of 89 participants
from birth to 17 years recruited consecutively as they were admitted
for cardiopulmonary bypass surgery. Creatinine measurements were
obtained the week before surgery, at eight hourly intervals in the first
24 hours post operatively, and then at 48 hours. A decline in creati-
nine clearance of
≥
25% from baseline was used as the threshold to
define AKI. Kidney injury was classified according to the RIFLE
system where patients are categorised as being at risk, having injury
and complete failure.
Results
: The overall prevalence of AKI was 37.1%. According to the
RIFLE system, risk occurred in 34.8%, injury in 11.2%, and failure
in 1.1% of patients. Patients with AKI were older, median age nine
years (IQR 3–12), compared to four years (IQR 1.5–8) for those
without AKI; 55% of AKI patients had moderate to severe malnutri-
tion compared to 34% of patients without AKI (OR 2.00,
p
=
0.17).
The median length of ICU stay in AKI patients was four days (IQR
2–6). The mortality rate in AKI vs non-AKI patients was 15.2 and
9%, respectively (OR 1.8; 95% CI: 0.5–6.8,
p
=
0.37). Up to 18.2% of
AKI patients required dialysis compared to 5% of non-AKI patients
(OR 3.9; 95% CI: 0.9–16.9,
p
=
0.06).
Conclusion
: The prevalence of AKI following cardiopulmonary
bypass surgery in children and adolescents at the KNH and Mater
Hospitals was high (37.1%), and was found in older patients.
Malnutrition was associated with a two-fold risk of developing AKI.
649: INVASIVE PULMONARY BLOOD FLOW RESTRIC-
TION IN PRE-OPERATIVE MANAGEMENT OF PATIENTS
WITH HYPOPLASTIC LEFT HEART SYNDROME IN A
SINGLE LOW-VOLUME INSTITUTION
Anton Avramenko
1,2
, Vladimir Goryachev
2
, Irina Kozeva
1
, Sergey
Shorokhov
1
1
Samara Regional Clinical Cardiac Hospital, Samara, Russian
Federation
2
Samara State Medical University, Samara, Russian Federation
Background:
For patients with HLHS it is optimal to be in a stable
condition prior to undergoing the Norwood procedure. In the setting
of limited resources, the Norwood procedure sometimes has to be
postponed for several days, which may expose the patient to the nega-
tive effect of systemic hypoperfusion due to runoff into the pulmo-
nary circuit. In order to balance pulmonary and systemic blood flow,
different non-invasive measures can be used, but their effectiveness
and durability of effect are limited, and invasive measures may be
necessary to restrict pulmonary blood flow.
Methods:
Short-term ligation of the right pulmonary artery (rPA) (in
2007) or bilateral banding of pulmonary arteries (PAs) (from 2008
onward) were used as methods of invasive pulmonary blood flow
restriction (iPBFR). Indications for iPBFR were as follows: systemic
hypoperfusion with lactate level
>
5 mmol/l, and oliguria together
with ineffectiveness of non-invasive measures to limit pulmonary
blood flow. Nine out of 29 HLHS patients required invasive pulmo-
nary blood flow restriction from 2005 to 2011. Three temporary rPA
ligations and six bilateral bandings of PAs were performed. Blood
gas and metabolite level analyses were performed on a regular basis
before and after iPBFR.
Results:
The patients’ mean body weight was 3.1
±
0.56 kg. iPBFR
