• Jianhui Wang, Chunrong Wang, Yuefu Wang, Yuchen Gao, Yu Tian, Sudena Wang, Jun Li, Lijing Yang, Yong G Peng, and Fuxia Yan.
• Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
• J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1565-1572.

ObjectiveTo investigate the prevalence, risk factors, and clinical outcomes associated with early fluid overload (FO) in a special group of pediatric patients undergoing repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).DesignIt was a retrospective study performed with multiple variable regression analysis.SettingA single cardiac surgical institution.ParticipantsEighty-eight patients younger than 18 years of age undergoing ALCAPA surgical repair with cardiopulmonary bypass were recruited at the authors' institution from June 2010 to September 2017.InterventionNone.Measurements And Main ResultsOf 88 pediatric patients with ALCAPA after surgical repair, 37.5% developed early FO, defined as fluid accumulation ≥5% within the period from surgery until midnight of postoperative day 1. Patients with early FO were younger, weighed less, and had worse preoperative cardiac dysfunction. With logistic regression analysis, being underweight was confirmed to be a risk factor for FO development (odds ratio, 8.66; 95% confidence interval, 2.83-26.52; p < 0.001). Early FO also predicted severe acute kidney injury, respiratory morbidity, and low cardiac output syndrome after reimplantation procedure. Patients with early FO also had significantly longer mechanical ventilation hours (p  <  0.001), intensive care unit length of stay (p = 0.003), and hospital length of stay (p = 0.009).ConclusionEarly FO ≥5% has been linked to adverse postoperative outcomes in pediatric patients undergoing repair for ALCAPA. The use of restrictive fluid management is crucial for patients who have lower weight and poor myocardial function before and after complex surgical procedures such as in ALCAPA settings.Copyright © 2019 Elsevier Inc. All rights reserved.

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