Normothermic cardiopulmonary bypass and myocardial cardioplegic protection for neonatal arterial switch operation

Pouard, Philippe; Mauriat, Philippe; Ek, F.; Haydar, Ayman; Gioanni, Simone; Laquay, N.; Vaccaroni, L.; Vouhé, Pascal

doi:10.1016/j.ejcts.2006.07.032

Cited by 70 publications

(72 citation statements)

References 23 publications

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“…The main rationale for using hypothermic CPB is to preserve the brain, the kidneys and the heart from ischaemic injury by reducing basal metabolic rate and whole body inflammatory response [5,6]. However, this reduction has only a minimal impact on oxygen need [4]. Hypothermic CPB seems to delay, but not terminate, the inflammatory reaction induced by CPB as convincingly suggested by recent reports [1].…”

Section: Introductionmentioning

confidence: 61%

“…Hypothermic CPB seems to delay, but not terminate, the inflammatory reaction induced by CPB as convincingly suggested by recent reports [1]. Hypothermia has deleterious effects on myocardium by impairing microcirculation and many cellular functions [4]. Different perfusion protocols using normothermia and hypothermia were documented regarding their advantages and disadvantages [7][8][9].…”

Section: Introductionmentioning

confidence: 81%

“…Recently, several studies on paediatric population concluded satisfactory results [2][3][4]. The main rationale for using hypothermic CPB is to preserve the brain, the kidneys and the heart from ischaemic injury by reducing basal metabolic rate and whole body inflammatory response [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation

Aydemir¹,

Harmandar²,

Karaci³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES:To compare neonates receiving arterial switch operation (ASO) either with mild or moderate hypothermic cardiopulmonary bypass.METHODS: Forty neonates undergoing ASO were randomized to receive either mild (Mi > 32°C, n = 20) or moderate (Mo > 26°C, n = 20) hypothermic cardiopulmonary bypass (CPB) between April 2007 and June 2010. All patients were diagnosed with simple transposition of the great arteries. Mean age (Mi: 8.32 ± 4.5 days, Mo: 7.54 ± 5.0 days, P = 0.21) and body weight were similar in both groups (Mi: 3.64 ± 0.91 kg, Mo: 3.73 ± 0.84 kg, P = 0.14). Follow-up was 3.1 ± 2.5 years for all patients.RESULTS: Lowest perioperative rectal temperature was 33.5 ± 1.4°C (Mi) versus 28.2 ± 2.1°C (Mo) (P < 0.001). All patients safely weaned from CPB required lower doses of dopamine (Mi: 5.1 ± 2.4 µg/kg min, Mo: 6.5 ± 2.1 µ/kg min, P = 0.04), dobutamine (Mi: 7.2 ± 2.5 µg/kg min, Mo: 8.6 ± 2.4 µ/kg min, P = 0.04) and adrenalin (Mi: 0.02 ± 0.02 µg/kg min, Mo: 0.05 ± 0.03 µ/kg min, P = 0.03) in mild hypothermia group. Intraoperative blood transfusion (Mi: 190 ± 58 ml, Mo: 230 ± 24 ml, P = 0.03) and postoperative lactate levels (Mi: 2.7 ± 0.9 mmol/l, Mo: 3.1 ± 2.2 mmol/l, P = 0.02) were lower under mild hypothermia. Secondary chest closure was performed in 30% (Mi) versus 35% (Mo) (P = 0.65). Duration of inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15) days, P = 0.03), time to extubation (Mi: 108 (88-128) h, Mo: 128 (102-210) h, P = 0.04), lengths of intensive care unit (ICU) stay (Mi: 9 (5-14) days, Mo: 12 (10-18) days, P = 0.04) and hospital stay (Mi: 19 (10-29) days, Mo: 23 (15-37) days, P = 0.04) were significantly shorter under mild hypothermia. Two-year freedom from reoperation was 100% for both the groups. CONCLUSIONS:The ASO under mild hypothermia seemed to be beneficial for pulmonary recovery, need for inotropic support and length of ICU and hospital stay. No worse early-or intermediate-term effects of mild hypothermia were found.

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Section: Introductionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 81%

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Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation

Aydemir¹,

Harmandar²,

Karaci³

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

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“…Data collected from instances in which HTK solution has been used for high-risk patients with complex congenital heart disease remains rare (19)(20)(21)(22). A study of Fuwai Hospital compared the myocardial protective effect induced by HTK solution and conventional St. Thomas crystalloid cardioplegia on the long-term ischemic period (cross-clamping time, >90 min) during severe complex pediatric cardiac surgery without pulmonary arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Lin

Xiang-wei

Tang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.

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“…To overcome these side effects different therapeutic strategies are currently applied (Nour S, 2003), such as: a) pharmacological supports using antifibrinolytic (Cooper, 2006), inotropes, vasodilators, platelets, etc. (Nardell, 2009), but with some side effects as well (Ishida, zt al., 2004); b) normothermia: that becomes more practiced in CPB with some proven advantages over hypothermia (Pouard, et al, 2006), which may be explained because blood is nearly Newtonian at 37.2°C (Box, et al 2005). Meanwhile, the benefits of normothermia on myocardial protection and microcirculation improvements remain controversial (Rastan, et al, 2008), as the myocardium is already protected with doses of cardioplegia, while the perfusion of microcirculation is more or less helped by the FahraeusLindqvist effect due to hemodilution; c) total or partial absenteeism of CPB: that becomes popular with proven postoperative hemodynamic advantages, but it is still a challenging technique reserved for selected groups of patients (Shroyer, et al, 2009); d) pulsatile perfusion flow devices: in a matter to keep ESS some pulsatile CPB have proven advantages clinically and experimentally (Ündar, et al,1999); (Undar, et al 2006).…”

Section: Evaluation Of the Pulsatile Tube Devicementioning

confidence: 99%

“Flow and Rate”: Concept and Clinical Applications of a New Hemodynamic Theory

Nour¹

2012

Biophysics

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Normothermic cardiopulmonary bypass and myocardial cardioplegic protection for neonatal arterial switch operation

Abstract: Normothermic cardiopulmonary bypass is feasible for ASO and seems to allow a faster recovery time.

Cited by 70 publications

References 23 publications

Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation

Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

“Flow and Rate”: Concept and Clinical Applications of a New Hemodynamic Theory

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