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A systematic review of the evidence supporting post-operative medication use in congenital heart disease

Published online by Cambridge University Press:  19 April 2021

Elizabeth J. Thompson ,
Henry P. Foote ,
Caitlin E. King ,
Sabarish Srinivasan ,
Elizabeth C. Ciociola ,
Dennis Leung ,
Alexandre T. Rotta ,
Kevin D. Hill ,
Michael Cohen-Wolkowiez  and
Christoph P. Hornik Open the ORCID record for Christoph P. Hornik [Opens in a new window]
Elizabeth J. Thompson
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Henry P. Foote
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Caitlin E. King
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Sabarish Srinivasan
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
Elizabeth C. Ciociola
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
Dennis Leung
Affiliation:
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Alexandre T. Rotta
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
Michael Cohen-Wolkowiez
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
Christoph P. Hornik*
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
*
Author for correspondence: Dr C. P. Hornik, MD, PhD, MPH, Department of Pediatrics and Duke Clinical Research Institute, Duke University School of Medicine, PO Box 17969, Durham, NC 27715, USA. Tel: +1 919 684 8111; Fax: 919 681 9457. E-mail: christoph.hornik@duke.edu
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Abstract

Background:

Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass.

Methods:

We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass.

Results:

We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety.

Conclusion:

In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

Keywords

post-operative carepediatricscongenital heart diseasecardiopulmonary bypassmedication use
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 707 - 733
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

Visiting high school student at Duke Clinical Research Institute, Durham, NC, USA.

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