Macro- to microcirculation approach for postoperative monitoring in adult congenital heart surgery

Karla A. Pupiales-Dávila, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Edgar García-Cruz, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Rodrigo Gopar-Nieto, Unidad de Urgencias y Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Monserrath Basilio-Téllez, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Stephanie T. Angulo-Cruzado, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jorge Sánchez-Nieto, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jorge L. Cervantes-Salazar, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Antonio Benita-Bordes, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Juan Calderón-Colmenero, Departamento de Cardiopatías Congénitas del Adulto, nstituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
José A. García-Montes, Department of Interventional Cardiology for Congenital Heart Disease. National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
Gustavo Rojas-Velasco, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Manzur-Sandoval, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Objective: To evaluate the relationship between macrocirculatory parameters, global oxygenation indices, and CO2 derived indices during the first 24 postoperative hours in adults with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB), and to analyze their association with clinical outcomes. Method: Observational, retrospective, cross-sectional study conducted between June 2022 and December 2024. Adult patients with congenital heart disease undergoing cardiac surgery with CPB were included. Demographic, surgical, hemodynamic, and clinical outcome variables were collected. The evolution of cardiac output, central venous pressure, mixed venous oxygen saturation, lactate, Δv-aCO2, Δv-aCO2/Δa-vO2, and oxygen extraction ratio was analyzed. Results: Fifty-nine patients were included (median age: 33 years), most whit moderate complexity congenital heart disease and preserved ventricular function. Median intensive care unit stay was 2 days, and in-hospital mortality was 5.2%. During the first 24 hours, cardiac output and cardiac index remained stable, mixed venous oxygen saturation showed a slight initial decrease, and CO2-derived indices reflected transient hypoperfusion with subsequent normalization. The need for vasoactive support decreased rapidly. The most frequent complications were hypovolemia (23.7%) and low cardiac output syndrome (11.9%). Conclusions: Despite anatomical complexity, patients exhibited favorable postoperative evolution. CO2-derived indices and global oxygenation parameters were useful as complementary markers of tissue hypoperfusion, suggesting their potential value in monitoring and risk stratification in adults with congenital heart disease undergoing cardiac surgery with CPB.

Keywords: Congenital heart Disease. Cardiac surgery. Cardiopulmonary bypass. Hemodynamic monitoring. Tissue hypoperfusion.