Efficacy and Safety of Esmolol in Neonatal Cardiac Surgery with Cardiopulmonary Bypass (CPB) for Transposition of the Great Arteries (TGA)

Background: Transposition of the great arteries (TGA) is the most common congenital heart disease requiring surgical correction within the neonatal period. Sinus tachycardia often persists postoperatively, potentially affecting cardiac function. Aim of this study was to evaluate efficacy and safety of the short-acting β-1-selective β-blocker esmolol in controlling heart rate in neonatal cardiac surgery with cardiopulmonary bypass (CPB).

Methods: All neonates who underwent arterial switch operation for d-TGA between 2012–2021 at our institution were included in this retrospective analysis. Subjects with need for postoperative ECMO support were excluded. Hemodynamic parameters were analyzed and compared between children with and without postoperative esmolol therapy.

Results: A total of 112 subjects were identified of whom 57/110 (52%) children received esmolol within the first 12 hour following CPB. The median age was 7 (IQR 5–9) days, median body weight was 3.4 (IQR3.0–3.8) kg. Esmolol dosage was titrated following heart rate with a median start dose of 31 (IQR 22–49) mcg/kg/min and a median maximum dose of 71 (46–101) mcg/kg/min. In the esmolol group, median heart rate at ICU admission was significantly higher compared with the control group (155 vs. 147 bpm, p = 0.018). After a median time of 11 hours, heart rate was lower among the esmolol patients (135 vs. 144 bpm, p < 0.001). There were no differences in any other hemodynamic parameters (blood pressure, central venous pressure, arterial oxygen saturation, central venous oxygen saturation, AVDO2, NIRS, lactate concentration, troponin I concentration) between the two groups. Patients treated with esmolol required longer catecholamine support while no difference regarding survival, duration of invasive ventilation and ICU stay were present.

Conclusion: Postoperative treatment with esmolol was safe and effective for the treatment of sinus tachycardia following CPB in neonates undergoing arterial switch operation. No relevant side effects were noticed among the patients treated with esmolol while outcome was identical with subjects without postoperative sinus tachycardia.

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Artikel online veröffentlicht:
13. Februar 2024