Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
With Dr. Joe La Hillier & Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The CDH study group does not prescribe standardized management protocols; they allow institutions to report cardiac dysfunction as yes/no and specify whether it is systolic or diastolic.
Pulmonary hypertension is a predictor of mortality for CDH infants.
In CDH with pulmonary hypertension, you can see decreased right ventricular ejection, which can lead to bowing of the septum into the left ventricle, resulting in decreased ventricular volumes and decreased ejection.
Cryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results.
Protocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study.
The CDH study group collected patient data from 2015 to 2018 in a retrospective review of prospectively collected data examining cardiac dysfunction within the first 48 hours of life.
Among all CDH patients in the study period, 39% had some evidence of cardiac dysfunction on their first echocardiogram in the first 48 hours of life.
Patients with normal cardiac function had a survival of over 80% on adjusted analysis.
Patients with right ventricular dysfunction only had a survival of 74%.
Patients with left ventricular dysfunction had a survival of 57%.
Patients with biventricular dysfunction had a survival of 50%, the worst risk profile.
Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality in CDH.
The standardized post-operative protocol for Nuss pectus repair included scheduled anti-emetics, epidural pain control discontinued on post-op day 2, early Foley removal, and encouraged ambulation.
The standardized protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days.
There were zero readmissions out of 164 patients in the Nuss pectus repair standardization study.
The Cincinnati Children's pectus protocol did not use cryotherapy for pain control in any patients.
The Cincinnati authors acknowledged studies showing cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy, yet expressed reservations due to lack of long-term outcomes data.