Controversy continues concerning the utilization of pulsatile flow during cardiopulmonary bypass (CPB) procedures with regard to improved patient outcomes. We evaluated 215 consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease who were prospectively entered into the study and randomly assigned to either the pulsatile perfusion group (group P, n = 151) or the nonpulsatile perfusion group (group NP, n = 64). All patients received identical surgical, perfusional, and postoperative care. Major complications and clinical outcome were documented. There were no statistically significant differences seen in either preoperative or operative parameters between the two groups (age, body surface area, weight, X-clamp and CPB time, base flow, flow rates, and hemofiltration). Group P, compared with group NP, had significantly less inotropic support (number of agents 1.4 +/- 0.07 vs. 2 +/- 0.12, p = 0.0012; dopamine 7.14 +/- 0.28 vs. 9.04 +/- 0.42 microg 32 x kg x min, p = 0.00025; dobutamine 4.12 +/- 0.3 vs. 5.3 +/- 0.6 microg 32 x kg x min, p = 0.036), adrenalin (0.026 +/- 0.005 vs. 0.046 +/- 0.005 microg 32 x kg x min, p = 0.021), shorter intubation period (10.26 +/- 1.04 vs. 18.64 +/- 1.99 hours, p = 0.021), shorter duration of intensive care unit (ICU) (1.53 +/- 0.07 vs. 2.75 +/- 1.19 days, p = 0.012), and hospital stay (6.71 +/- 0.19 vs. 11.16 +/- 0.58 days, p = 0.002). Although there were no significant differences in either creatinine, enzyme levels, and drainage amounts between two groups, lower lactate levels 16.27 +/- 2.02 vs. 24.66 +/- 3.05 mg/dl, p = 0.00034), higher albumine levels (3.15 +/- 0.03 vs. 2.95 +/- 0.06 mg/dl, p = 0.046), and higher urine output (602.82 +/- 21.5 vs. 505.55 +/- 34.2 ml/d, p = 0.016) during ICU period was observed in group P compared with group NP, respectively. We concluded that the use of pulsatile flow resulted in improved patient outcomes in terms of preserving better cardiac, renal, and pulmonary functions in the early post-CPB period.

Peritoneal dialysis after complex congenital cardiac surgery was introduced to a group of neonates and infants (n = 756; age, 0 to 1 year) between May 1993 and December 2005. Indications of peritoneal dialysis were determined as well as methods, prolonged dialysis, and its outcomes. Demographic characteristics, preoperative risk factors, intraoperative variables, and postoperative complications were compared in 756 cases with ages below 1 year. All cases underwent ultrafiltration during the perioperative stage. One hundred eighty-six cases (24.6% of total) required peritoneal dialysis. The cardiac pathology was transposition of great arteries in 133 cases, tetralogy of Fallot in 37, aorticopulmonary window associated with interrupted aortic arch in 4 and total anomalous pulmonary venous return in 5, and other complex pathology in 7 cases. Prolonged peritoneal dialysis was usually required in infants with low weight, with episodes of pulmonary hypertensive crisis (p < 0.05), and with preoperative renal dysfunction. No major complication was observed related to the peritoneal dialysis catheter. Of 186 patients, 23 (12.3%) had acute renal failure, and 4 of them died (2.15% of all patients underwent operation, 17.3% of those with acute renal failure). It has been demonstrated that the combination of peritoneal dialysis with perioperative ultrafiltration application was effective in providing the required postoperative negative fluid balance in especially complex congenital heart cases and affected survival positively.