Circulating amino acid levels in infants undergoing congenital heart disease surgery: near global decrease following cardiopulmonary bypass and impact of perioperative feeding patterns.

INTRODUCTION

Amino acids (AAs) serve diverse roles, and insufficient delivery is associated with worse outcomes in ill patients. In the case of congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB), AA levels are often dysregulated. Changes at the individual AA level, impact of clinical factors, and association with outcomes are less understood.

OBJECTIVES

We evaluated AA levels at multiple timepoints, the impact of pre-operative nutrition on these levels, and their association with the combined outcome: cardiac arrest, death, mechanical circulatory support, or ICU length of stay (LOS) above the 75% quantile of the cohort.

METHODS

Infants < 120 days undergoing CHD surgery with CPB were evaluated, excluding those < 2 kg or 34 weeks corrected gestational age. Relative AA quantification was performed pre-operatively, during rewarming, and 24 h post-ICU admission. Partial least squares discriminant analysis was used to compare AA levels between timepoints and feeding status. Univariate and multivariate analysis assessed for association with the combined outcome.

RESULTS

16 of 19 AAs decreased during rewarming with 11 continuing to decrease at 24 h. Patients who did not receive enteral feeds pre-operatively had lower levels of certain AAs. Univariate analysis identified that decreased levels of glutamine, aspartate, and glutamate, and increased phenylalanine and lysine levels, were associated with increased risk of the combined outcome.

CONCLUSION

AA levels decreased following CPB and are impacted by pre-operative feeding status. Decreased levels of certain AAs are associated with increased risk of the combined outcome. Emphasizing pre-operative enteral nutrition and post-operative AA supplementation could improve outcomes in this population.