• Raul Abella, Angela Satriano, Alessandro Frigiola, Alessandro Varrica, Antonio Dw Gavilanes, Luc J Zimmermann, Hans Js Vles, Pasquale Florio, Maria Grazia Calevo, and Diego Gazzolo.
• Department of Pediatric Cardiac Surgery IRCCS, San Donato Milanese Hospital, San Donato Milanese, Italy.
• J. Matern. Fetal. Neonatal. Med. 2012 Dec 1; 25 (12): 2756-61.

BackgroundLow cardiac output syndrome (LCOS) remains a major perioperative complications in infants subjected to open-heart surgery with cardiopulmonary bypass (CPB). The present study investigated whether perioperative blood assessment of a potent vasoactive peptide namely adrenomedullin (AM) can predict the risk of LCOS.MethodsWe measured AM levels in 48 patients (LCOS: n = 9; controls: n = 39) undergone to open-heart surgery with CPB at five predetermined time points before, during and after the surgery. Clinical, laboratory and perioperative data were analyzed by a multiple logistic regression model.ResultsAM significantly decreased (p < 0.01) during and after the surgical procedure exhibiting a dip at the end of the CPB. Multivariable analysis demonstrated significant correlations among LCOS, AM measured at the end of CPB (p < 0.001), and cooling duration (p < 0.05). AM at 27 pg/L cutoff achieved a sensitivity of 100% and a specificity of 64.1%, while cooling at 11-min cutoff combined a sensitivity of 55.6% and a specificity of 92.3% for LCOS prediction.ConclusionsThis study suggests that AM can constitute, alone or combined with standard parameters, a promising predictor of LCOS in infants subjected to open-heart surgery with CPB.

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