Factors Associated with Oxygen Extraction Ratio and Pulmonary to Systemic Blood Flow in Parallel Circulation: Insights from Cardiac Catheterization Data
Article Sidebar
Main Article Content
Abstract
Introduction: Functionally univentricular parallel circulation represents one of the highest-risk circulatory physiologies for humans. With the arterial saturation linked to both the pulmonary venous and systemic venous saturations and total cardiac output being the sum of systemic and pulmonary blood flow, this circulation is truly unique. Maintaining adequate oxygen delivery is important, and oxygen extraction has been demonstrated to be associated with outcomes. This study aimed to characterize relationships between various hemodynamic parameters and oxygen extraction in this circulation.
Methods: Data from the pre-Glenn catheterization in children with functionally univentricular parallel circulation were utilized to determine relationships between various hemodynamic parameters and oxygen extraction. Oxygen extraction was calculated using the superior caval vein saturation.
Results: Data from 45 catheterizations across 45 unique patients were included in these analyses. Higher systemic blood flow, higher total cardiac output, lower pulmonary to systemic blood flow ratio, higher hemoglobin, and lower systemic vascular resistance were found to be associated with lower oxygen extraction.
Conclusion: Catheterization data demonstrate that a variety of hemodynamic parameters are associated with oxygen extraction. These may be clinically monitored and utilized to help augment oxygen extraction.
Downloads
Article Details
Copyright (c) 2025 Loomba RS, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Lawrenson J, Eyskens B, Vlasselaers D, Gewillig M. Manipulating parallel circuits: the perioperative management of patients with complex congenital cardiac disease. Cardiol Young. 2003;13:316–22. Available from: https://pubmed.ncbi.nlm.nih.gov/14694949/
Dhillon SX, Zhang G, Cai S, Jia L. Clinical hemodynamic parameters do not accurately reflect systemic oxygen transport in neonates after the Norwood procedure. Congenit Heart Dis. 2015;:234–9. Available from: https://doi.org/10.1111/chd.12196
Francis DP, Willson K, Thorne SA, Davies LC, Coats AJ. Oxygenation in patients with a functionally univentricular circulation and complete mixing of blood: are saturation and flow interchangeable? Circulation. 1999;100:2198–203. Available from: https://doi.org/10.1161/01.cir.100.21.2198
Hoffman GM, Ghanayem NS, Kampine JM, Berger S, Mussatto KA, Litwin SB. Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg. 2000;70:1515–20; discussion 1521. Available from: https://doi.org/10.1016/s0003-4975(00)01772-0
Taeed R, Schwartz SM, Pearl JM, Raake JL, Beekman RH 3rd, Manning PB. Unrecognized pulmonary venous desaturation early after Norwood palliation confounds Gp:Gs assessment and compromises oxygen delivery. Circulation. 2001;103:2699–704. Available from: https://doi.org/10.1161/01.cir.103.22.2699
Tweddell JS, Ghanayem NS, Mussatto KA, Mitchell ME, Lamers LJ, Musa NL, et al. Mixed venous oxygen saturation monitoring after stage 1 palliation for hypoplastic left heart syndrome. Ann Thorac Surg. 2007;84:1301–10; discussion 1310–1. Available from: https://doi.org/10.1016/j.athoracsur.2007.05.047
Hoffman GM, Ghanayem NS, Scott JP, Tweddell JS, Mitchell ME, Mussatto KA. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg. 2017;103:1527–35. Available from: https://doi.org/10.1016/j.athoracsur.2016.09.100
Barnea O, Santamore WP, Rossi A, Salloum E, Chien S, Austin EH. Estimation of oxygen delivery in newborns with a univentricular circulation. Circulation. 1998;98:1407–13. Available from: https://doi.org/10.1161/01.cir.98.14.1407
Photiadis J, Sinzobahamvya N, Fink C, Schneider M, Schindler E, Brecher AM, et al. Optimal pulmonary to systemic blood flow ratio for best hemodynamic status and outcome early after Norwood operation. Eur J Cardiothorac Surg. 2006;29:551–6. Available from: https://doi.org/10.1016/j.ejcts.2005.12.043
Bradley SM, Atz AM, Simsic JM. Redefining the impact of oxygen and hyperventilation after the Norwood procedure. J Thorac Cardiovasc Surg. 2004;127:473–80. Available from: https://doi.org/10.1016/j.jtcvs.2003.09.028
Hoffman GM, Tweddell JS, Ghanayem NS, Mussatto KA, Stuth EA, Jaquis RD, et al. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg. 2004;127:738–45. Available from: https://doi.org/10.1016/s0022-5223(03)01315-1
Kuo JA, Maher KO, Kirshbom PM, Mahle WT. Red blood cell transfusion for infants with single-ventricle physiology. Pediatr Cardiol. 2011;32:461–8. Available from: https://doi.org/10.1007/s00246-011-9901-3
Patel RD, Weld J, Flores S, Villarreal EG, Farias JS, Lee B, et al. The Acute Effect of Packed Red Blood Cell Transfusion in Mechanically Ventilated Children after the Norwood Operation. Pediatr Cardiol. 2022;43(2):401-406. Available from: https://doi.org/10.1007/s00246-021-02735-6
Lister G, Hellenbrand WE, Kleinman CS, Talner NS. Physiologic effects of increasing hemoglobin concentration in left-to-right shunting in infants with ventricular septal defects. N Engl J Med. 1982;306:502–6. Available from: https://doi.org/10.1056/nejm198203043060902
Savorgnan F, Bhat PN, Checchia PA, Savorgnan F, Bhat PN, Checchia PA, et al. RBC transfusion-induced ST segment variability following the Norwood procedure. Crit Care Explor. 2021;3:e0417. Available from: https://doi.org/10.1097/cce.0000000000000417
Lee B, Villarreal EG, Mossad EB, Rausa J, Bronicki RA, Flores S, et al. Alpha-blockade during congenital heart surgery admissions: analysis from the national database. Cardiol Young. 2021;1–7. Available from: https://doi.org/10.1017/S1047951121003875
Hoffman GM, Scott JP, Ghanayem NS, Stuth EA, Mitchell ME, Woods RK, et al. Identification of time-dependent risks of hemodynamic states after stage 1 Norwood palliation. Ann Thorac Surg. 2020;109:155–62. Available from: https://doi.org/10.1016/j.athoracsur.2019.06.063
Tweddell JS, Hoffman GM, Fedderly RT, Ghanayem NS, Kampine JM, Berger S, et al. Patients at risk for low systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg. 2000;69:1893–9. Available from: https://doi.org/10.1016/s0003-4975(00)01349-7
Tweddell JS, Hoffman GM, Fedderly RT, Berger S, Thomas JP Jr, Ghanayem NS, et al. Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg. 1999;67:161–7; discussion 167–8. Available from: https://doi.org/10.1016/s0003-4975(98)01266-1
Savorgnan F, Flores S, Loomba RS, Checchia PA, Bronicki RA, Farias JS, et al. Hemodynamic response to calcium chloride boluses in single-ventricle patients with parallel circulation. Pediatr Cardiol. 2021. Available from: https://doi.org/10.1007/s00246-021-02754-3
Li J, Zhang G, Holtby H, Humpl T, Caldarone CA, Van Arsdell GS, et al. Adverse effects of dopamine on systemic hemodynamic status and oxygen transport in neonates after the Norwood procedure. J Am Coll Cardiol. 2006;48:1859–64. Available from: https://doi.org/10.1016/j.jacc.2006.07.038
Loomba RS, Flores S. Use of vasoactive agents in postoperative pediatric cardiac patients: insights from a national database. Congenit Heart Dis. 2019;14:1176–84. Available from: https://doi.org/10.1111/chd.12837