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Beta-blocker use after complete repair of tetralogy of Fallot: an analysis of a national database

Part of: Surgery

Published online by Cambridge University Press:  08 July 2021

Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window] ,
Juan S. Farias ,
James S. Tweddell ,
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]  and
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]
Enrique G. Villarreal*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Juan S. Farias
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
James S. Tweddell
Affiliation:
Cincinnati Children’s Hospital Medical Center, The Heart Center, Cincinnati, OH, USA
Rohit S. Loomba
Affiliation:
Cardiology, Pediatrics, Advocate Children’s Hospital, Oak Lawn, IL, USA Medicine, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
Saul Flores
Affiliation:
Texas Children’s Hospital, Section of Critical Care and Cardiology/Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: Enrique G. Villarreal, MD, Department of Pediatrics, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico. Tel: +5218113244817. E-mail: quique_villarreal93@hotmail.com
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Abstract

Introduction:

In patients with right ventricular diastolic dysfunction after complete repair of tetralogy of Fallot, some employ the use of beta-blockade. The theoretical benefit of this therapy is felt to be one of the two: 1) reduction in heart rate with subsequent increase in diastolic filling time and stroke volume; 2) halting or reversal of right ventricular remodelling. This study aimed to characterise the use of beta-blockade in paediatric admissions with complete repair of tetralogy of Fallot and characterise the effects of beta-blockade on admission characteristics.

Methods:

Admissions from 2004 to 2015 in the Pediatric Health Information System database with complete repair of tetralogy of Fallot were identified. Characteristics between admissions with and without beta-blockade were compared by univariate analysis. Next, regression analyses were conducted to determine the independent association of beta-blockade on length of admission, billed charges, cardiac arrest, and inpatient mortality while controlling for demographic variables and comorbidities.

Results:

A total of 3594 admissions were included in the final analyses. Of these, 371 employed beta-blockade. Admissions with beta-blockade were more likely to have heart failure and tachyarrhythmias. These admissions also tended to be longer by univariate analysis. Regression analyses demonstrated that beta-blockade was independently associated with a 2.8-day increase in length of stay and no statistically significant change in billed charges, cardiac arrest, or inpatient mortality.

Conclusions:

Beta-blockade after complete repair of tetralogy of Fallot is associated with a longer length of stay but did not statistically significantly impact billed charges, cardiac arrest, or inpatient mortality.

Keywords

Tetralogy of Fallotadrenergic beta-antagonistsmortalitylength of stayCHDspaediatrics
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 4 , April 2022 , pp. 584 - 588
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Cardoso, SM and Miyague, NI. Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot. Arq Bras Cardiol 2003; 80: 198–201, 194–197.Google ScholarPubMed
Cullen, S, Shore, D, Redington, A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation 1995; 91: 1782–1789.CrossRefGoogle ScholarPubMed
Truccone, NJ, Spotnitz, HM, Gersony, WM, Dell, R, Bowman, FO Jr., Malm, JR. Cardiac output in infants and children after open-heart surgery. J Thorac Cardiovasc Surg 1976; 71: 410–414.10.1016/S0022-5223(19)40209-2CrossRefGoogle ScholarPubMed
Lindner, WS, Schaumberger, M, Rlegel, K, Versmold, HT. Regulation of cardiac output in sick neoantes. Heart rate or stroke volume? Pediatr Res 1988; 24: 281–282.CrossRefGoogle Scholar
Bombardini, T, Gemignani, V, Bianchini, E, et al. Diastolic time – frequency relation in the stress echo lab: filling timing and flow at different heart rates. Cardiovasc Ultrasound 2008; 6: 15.CrossRefGoogle ScholarPubMed
Johnston, WE, Robertie, PG, Dudas, LM, Kon, ND, Vinten-Johansen, J. Heart rate-right ventricular stroke volume relation with myocardial revascularization. Ann Thorac Surg 1991; 52: 797–804.10.1016/0003-4975(91)91214-GCrossRefGoogle ScholarPubMed
Pfeffer, MA, Braunwald, E, Moye, LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 1992; 327: 669–677.CrossRefGoogle ScholarPubMed
Pitt, B, Chang, P, Timmermans, PB. Angiotensin II receptor antagonists in heart failure: rationale and design of the evaluation of losartan in the elderly (ELITE) trial. Cardiovasc Drugs Ther 1995; 9: 693–700.CrossRefGoogle ScholarPubMed
Pitt, B, Segal, R, Martinez, FA, et al. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997; 349: 747–752.CrossRefGoogle Scholar
Cioffi, G, Stefenelli, C, Tarantini, L, Opasich, C. Prevalence, predictors, and prognostic implications of improvement in left ventricular systolic function and clinical status in patients >70 years of age with recently diagnosed systolic heart failure. Am J Cardiol 2003; 92: 166–172.CrossRefGoogle ScholarPubMed
Hoshikawa, E, Matsumura, Y, Kubo, T, et al. Effect of left ventricular reverse remodeling on long-term prognosis after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and beta blockers in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2011; 107: 1065–1070.CrossRefGoogle ScholarPubMed