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Eur J Cardiothorac Surg 2005;28:229-233
© 2005 Elsevier Science NL

Original articles

Metabolic alkalosis after pediatric cardiac surgery

^a Department of Cardiothoracic Surgery, Thoraxcenter, Bd 156, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
^b Department of Pediatric Cardiology, Erasmus M C, Rotterdam, The Netherlands

Received 22 December 2004; received in revised form 29 March 2005; accepted 25 April 2005.

^* Corresponding author. Tel.: +31 10 4635411; fax: +31 10 4633993. (Email: r.vanthiel{at}erasmusmc.nl).

Abstract

Objective: To determine occurrence, causes and associated mortality of postoperative metabolic alkalosis in pediatric cardiac surgery. Methods: We retrospectively analyzed clinical and biochemical variables of 186 consecutive cardiac operations other than ductal ligations on children less than 2 years old during the years 1999 and 2000. Metabolic alkalosis was defined as a pH>7.48 corrected for PCO₂, with a base excess 5 on two or more consecutive measurements during an 8h period. Results: Median age was 15 weeks [range 2 days–95 weeks] and median weight 4.5kg [range 2.1–15.7kg]. In 157 cases, cardiopulmonary bypass was used. In 92 [49%] procedures, metabolic alkalosis occurred with the highest corrected pH 24.3h after operation. Multivariate regression analysis associated age [P<0.001], cardiopulmonary bypass [P<0.001] and preoperative ductal dependency [P=0.04] with postoperative metabolic alkalosis. Of the surgical procedures the arterial switch for transposition of the great arteries [n=19] was strongly associated with metabolic alkalosis [100%, P<0.001]. Hemodilution appeared to enhance the development of alkalosis: those who experienced alkalosis had been hemodiluted to a greater extent [P=0.007]. Nearly 95% of patients experienced some increase in bicarbonate, but patients with metabolic alkalosis experienced more than those without [5.9 versus 3.5mmol/l, P<0.001]. There were four postoperative deaths, only one coincidental with metabolic alkalosis. Conclusions: Metabolic alkalosis has a high incidence after pediatric cardiac surgery, strongly associated with younger age, cardiopulmonary bypass, preoperative ductal dependency and perioperative hemodilution. Early recognition allows for timely therapeutic intervention.

Key Words: Alkalosis • Pediatrics • Cardiac surgery • Cardiopulmonary bypass • Ductus arteriosus