Airway ciliary dysfunction: Association with adverse postoperative outcomes in nonheterotaxy congenital heart disease patients

Eileen Stewart, Phillip S. Adams, Xin Tian, Omar Khalifa, Peter Wearden, Maliha Zahid, Cecilia W. Lo

Research output: Contribution to journalArticle

  • 2 Citations

Abstract

Objective: Heterotaxy (HTX) congenital heart disease (CHD) patients with ciliary dysfunction (CD) have been shown to have increased postoperative respiratory morbidity. We hypothesized that non-HTX CHD infants with CD also will have increased postoperative morbidity, particularly respiratory complications. Methods: Sixty-three infants with non-HTX CHD undergoing cardiac surgery were enrolled. Tests commonly used to assess for CD, nasal nitric oxide (nNO) measurements and nasal epithelial ciliary motion (CM) assessment, were obtained. Baseline characteristics and postoperative outcomes were collected and analyzed. Results: Non-HTX CHD infants exhibited a high prevalence of abnormal CM (32%) and low nNO (39%). This finding was not correlated with demographics or surgical complexity. Infants with abnormal CM had increased odds of requiring noninvasive positive pressure ventilation (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.5-29.4; P =.016) and respiratory medication use (OR, 4.4; 95% CI, 1.5-13.3; P =.01). In contrast, infants with low nNO showed evidence of abnormal pre- and postoperative systolic function (40% vs 4%; P =.004, and 34% vs 13%; P =.056, respectively) and had greater odds of acquiring infections (OR, 4.9; 95% CI, 1.4-17; P =.014). Conclusions: Non-HTX CHD infants with abnormal CM showed increased postoperative morbidity associated with poor respiratory outcomes. In contrast, low nNO correlated with reduced hemodynamic function. These findings suggest screening for abnormal CM may allow perioperative interventions to reduce pulmonary morbidities. Whether low nNO may prognosticate poor hemodynamic function warrants further investigation.

LanguageEnglish (US)
Pages755-763.e7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number2
DOIs
StatePublished - Feb 1 2018

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Nose
Heart Diseases
Nitric Oxide
Morbidity
Odds Ratio
Confidence Intervals
Hemodynamics
Positive-Pressure Respiration
Thoracic Surgery
Demography
Lung
Infection

Keywords

  • airway epithelia
  • congenital heart disease
  • nitric oxide
  • postsurgical outcome
  • primary ciliary dyskinesia
  • respiratory cilia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Airway ciliary dysfunction : Association with adverse postoperative outcomes in nonheterotaxy congenital heart disease patients. / Stewart, Eileen; Adams, Phillip S.; Tian, Xin; Khalifa, Omar; Wearden, Peter; Zahid, Maliha; Lo, Cecilia W.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 2, 01.02.2018, p. 755-763.e7.

Research output: Contribution to journalArticle

Stewart, Eileen ; Adams, Phillip S. ; Tian, Xin ; Khalifa, Omar ; Wearden, Peter ; Zahid, Maliha ; Lo, Cecilia W. / Airway ciliary dysfunction : Association with adverse postoperative outcomes in nonheterotaxy congenital heart disease patients. In: Journal of Thoracic and Cardiovascular Surgery. 2018 ; Vol. 155, No. 2. pp. 755-763.e7.
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abstract = "Objective: Heterotaxy (HTX) congenital heart disease (CHD) patients with ciliary dysfunction (CD) have been shown to have increased postoperative respiratory morbidity. We hypothesized that non-HTX CHD infants with CD also will have increased postoperative morbidity, particularly respiratory complications. Methods: Sixty-three infants with non-HTX CHD undergoing cardiac surgery were enrolled. Tests commonly used to assess for CD, nasal nitric oxide (nNO) measurements and nasal epithelial ciliary motion (CM) assessment, were obtained. Baseline characteristics and postoperative outcomes were collected and analyzed. Results: Non-HTX CHD infants exhibited a high prevalence of abnormal CM (32{\%}) and low nNO (39{\%}). This finding was not correlated with demographics or surgical complexity. Infants with abnormal CM had increased odds of requiring noninvasive positive pressure ventilation (odds ratio [OR], 6.5; 95{\%} confidence interval [CI], 1.5-29.4; P =.016) and respiratory medication use (OR, 4.4; 95{\%} CI, 1.5-13.3; P =.01). In contrast, infants with low nNO showed evidence of abnormal pre- and postoperative systolic function (40{\%} vs 4{\%}; P =.004, and 34{\%} vs 13{\%}; P =.056, respectively) and had greater odds of acquiring infections (OR, 4.9; 95{\%} CI, 1.4-17; P =.014). Conclusions: Non-HTX CHD infants with abnormal CM showed increased postoperative morbidity associated with poor respiratory outcomes. In contrast, low nNO correlated with reduced hemodynamic function. These findings suggest screening for abnormal CM may allow perioperative interventions to reduce pulmonary morbidities. Whether low nNO may prognosticate poor hemodynamic function warrants further investigation.",
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AU - Stewart, Eileen

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AU - Khalifa, Omar

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AU - Zahid, Maliha

AU - Lo, Cecilia W.

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N2 - Objective: Heterotaxy (HTX) congenital heart disease (CHD) patients with ciliary dysfunction (CD) have been shown to have increased postoperative respiratory morbidity. We hypothesized that non-HTX CHD infants with CD also will have increased postoperative morbidity, particularly respiratory complications. Methods: Sixty-three infants with non-HTX CHD undergoing cardiac surgery were enrolled. Tests commonly used to assess for CD, nasal nitric oxide (nNO) measurements and nasal epithelial ciliary motion (CM) assessment, were obtained. Baseline characteristics and postoperative outcomes were collected and analyzed. Results: Non-HTX CHD infants exhibited a high prevalence of abnormal CM (32%) and low nNO (39%). This finding was not correlated with demographics or surgical complexity. Infants with abnormal CM had increased odds of requiring noninvasive positive pressure ventilation (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.5-29.4; P =.016) and respiratory medication use (OR, 4.4; 95% CI, 1.5-13.3; P =.01). In contrast, infants with low nNO showed evidence of abnormal pre- and postoperative systolic function (40% vs 4%; P =.004, and 34% vs 13%; P =.056, respectively) and had greater odds of acquiring infections (OR, 4.9; 95% CI, 1.4-17; P =.014). Conclusions: Non-HTX CHD infants with abnormal CM showed increased postoperative morbidity associated with poor respiratory outcomes. In contrast, low nNO correlated with reduced hemodynamic function. These findings suggest screening for abnormal CM may allow perioperative interventions to reduce pulmonary morbidities. Whether low nNO may prognosticate poor hemodynamic function warrants further investigation.

AB - Objective: Heterotaxy (HTX) congenital heart disease (CHD) patients with ciliary dysfunction (CD) have been shown to have increased postoperative respiratory morbidity. We hypothesized that non-HTX CHD infants with CD also will have increased postoperative morbidity, particularly respiratory complications. Methods: Sixty-three infants with non-HTX CHD undergoing cardiac surgery were enrolled. Tests commonly used to assess for CD, nasal nitric oxide (nNO) measurements and nasal epithelial ciliary motion (CM) assessment, were obtained. Baseline characteristics and postoperative outcomes were collected and analyzed. Results: Non-HTX CHD infants exhibited a high prevalence of abnormal CM (32%) and low nNO (39%). This finding was not correlated with demographics or surgical complexity. Infants with abnormal CM had increased odds of requiring noninvasive positive pressure ventilation (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.5-29.4; P =.016) and respiratory medication use (OR, 4.4; 95% CI, 1.5-13.3; P =.01). In contrast, infants with low nNO showed evidence of abnormal pre- and postoperative systolic function (40% vs 4%; P =.004, and 34% vs 13%; P =.056, respectively) and had greater odds of acquiring infections (OR, 4.9; 95% CI, 1.4-17; P =.014). Conclusions: Non-HTX CHD infants with abnormal CM showed increased postoperative morbidity associated with poor respiratory outcomes. In contrast, low nNO correlated with reduced hemodynamic function. These findings suggest screening for abnormal CM may allow perioperative interventions to reduce pulmonary morbidities. Whether low nNO may prognosticate poor hemodynamic function warrants further investigation.

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KW - congenital heart disease

KW - nitric oxide

KW - postsurgical outcome

KW - primary ciliary dyskinesia

KW - respiratory cilia

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