Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time

Durandy, Yves; Younès, M.; Mahut, Bruno

doi:10.1016/j.athoracsur.2008.08.004

Cited by 30 publications

(20 citation statements)

References 32 publications

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“…The aim of this work was to describe brain MRI findings before and after arterial switch operation using warm perfusion in neonates. We have previously demonstrated the feasibility and the safety of pediatric normothermic full‐flow perfusion (9), but to our knowledge, there is no reported study of pre‐ and postoperative brain MRI results for neonates undergoing warm surgery with cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Pre- and Postoperative Magnetic Resonance Imaging in Neonatal Arterial Switch Operation Using Warm Perfusion

et al. 2011

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Neurological morbidity is a major concern in pediatric cardiac surgery. Cardiopulmonary bypass is one of the few modifiable factors affecting neurodevelopmental outcome. This study aimed to measure the incidence of abnormalities apparent by magnetic resonance imaging (MRI) after neonatal arterial switch operation using warm surgery. Neonates admitted for transposition of the great arteries underwent pre- and postoperative brain MRI. They were operated on using a warm perfusion method. The data collected included antenatal diagnosis, place of birth, gestational age, total maturation score as described by Childs, weight, cyanosis as assessed by minimal SpO(2) sustained for at least 10 min, balloon atrial septostomy, prostaglandin E1 infusion, need for neonatal intensive care, bypass time, time to extubation, and length of stay in intensive care. All of the MRI results were interpreted by the same senior specialist in pediatric neuroimaging, and lesions were classified as white matter injury, infarct, or hemorrhage. On preoperative exam, nine patients (42%) had one or more lesions, with infarct in four patients, white matter injury in four patients, and hemorrhage in five. We were unable to find any correlation between the data collected and brain injury. On postoperative exam, there was one new infarct, two new cases of white matter injury, and three cases of hemorrhage but no worsening of the preoperative lesions. Based on this initial experience with brain imaging, there is no deleterious effect of warm perfusion and no rationale to postpone surgery in neonates with "subclinical" brain injury.

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Section: Discussionmentioning

confidence: 99%

Pre- and Postoperative Magnetic Resonance Imaging in Neonatal Arterial Switch Operation Using Warm Perfusion

et al. 2011

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“…However, in Group NP, the reduction in FT3 and FT4 was significantly larger both during CPB and at 72 h postoperation. Several possible mechanisms have been linked to the abnormalities of thyroid hormones during CPB, including hemodilution, medication, hypothermia, and increased concentrations of inflammatory mediators (21)(22)(23). Our finding that pulsatile perfusion caused less reduction in the plasma level of FT 3 and FT4 than nonpulsatile perfusion may be attributed to the inhibitory effect of pulsatile perfusion on the inflammatory cytokine activity (9,19), but more studies are needed to identify the interaction of perfusion pattern and thyroid axis, as well as other involved organ systems.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass

et al. 2010

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The objectives of this study were: (i) to evaluate the effects of perfusion modes (pulsatile vs. nonpulsatile) on vital organs recovery and (ii) to investigate the influences of two different perfusion modes on the homeostasis of thyroid hormones in pediatric patients undergoing cardiopulmonary bypass (CPB) procedures. Two hundred and eighty-nine consecutive pediatric patients undergoing open heart surgery for repair of congenital heart disease were prospectively entered into the study and were randomly assigned to two groups: the pulsatile perfusion group (Group P, n = 208) and the nonpulsatile perfusion group (Group NP, n = 81). All patients received identical surgical, perfusional, and postoperative care. Study parameters included total drainage, mean urine output in the intensive care unit (ICU), intubation time, duration of ICU and hospital stay, the need for inotropic support, pre- and postoperative enzyme levels (ALT [alanine aminotransaminase] and AST [aspartate aminotransaminase]), c-reactive protein, lactate, albumin, blood count (leukocytes, hematocrit, platelets), creatinine levels, and thyroid hormones (thyroid stimulating hormone [TSH], FT(3) [free triiodothyronine], FT(4) [free thyroxine]). All patients survived the perioperative and postoperative periods. There were no statistically significant differences in either preoperative or operative parameters between the two groups. Group P, compared to Group NP, required significantly less inotropic support, had a shorter intubation period, higher urine output in ICU, and shorter duration of ICU and hospital stay. Lower lactate levels and higher albumin levels were observed in Group P and there were no significant differences in creatinine, enzyme levels, blood counts, or drainage amounts between two groups. TSH, Total T(3) , Total T(4) , and FT(3) , FT(4) levels were markedly reduced versus their preoperative values in both groups. FT(3) and FT(4) levels were reduced significantly further in the nonpulsatile group both during CPB and at 72 h postoperation. The results of this study confirm our opinion that pulsatile perfusion leads to better vital organ recovery and clinical outcomes in the early postoperative period as compared to nonpulsatile perfusion in pediatric patients undergoing CPB cardiac surgery. The plasma concentrations of thyroid hormones are dramatically reduced during and after CPB, but pulsatile perfusion seems to have a protective effect of thyroid hormone homeostasis compared to nonpulsatile perfusion.

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“…Open heart surgery 2 Cardiopulmonary bypass machine 3 Extra corporal circulation 4 Closed heart surgery 5 Patent ductus arteriosus 6 Femoral vein 7 Femoral artery 8 Congenital heart disease 9 Anomalous coronary arteries 10 Anomalous left coronary artery from the pulmonary artery 11 Anomalous aortic origin of coronary artery 12 Aortic stenosis 13 Aorto pulmonary window 14 Atrial septal defect…”

Section: ‫مقاله:‬ ‫اطالعات‬mentioning

confidence: 99%

Incidence of Acute Neurologic Complications after Heart Surgery in Children with Congenital Heart Disease

استقامت¹,

استقامت²,

اشرفی³

et al. 2015

Shefaye Khatam

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According to the nature of heart diseases and the use of cardiopulmonary bypass, transient or permanent neurologic complications may arise during or after pediatric cardiac surgery. The aim of this study was to evaluate the incidence of acute neurologic complications in postoperative cardiac surgery period in children with congenital heart diseases (CHD) undergoing cardiac surgery. Materials and Methods: In this study, all patients with cardiovascular disease (including CHD and other cardiovascular diseases) had been operated (open or closed) in the Children's Medical Center, Tehran, Iran, were evaluated for a year between July 2014 and July 2015. Those who had died during hospital stay or surgery, patients with incomplete information in their medical records, and children who had not been operated because of CHD were excluded. Of the 435 patients surveyed, 364 patients were enrolled in this study. Acute neurologic complications and related findings in brain CT scan were investigated. Results: The age range for patients was between 5 days to 15 years old, of whom 64 (17.6%) patients were under 2 months, 131 (36%) patients were between 2 months to 1 year, and 169 (46.6%) patients were over one year. Thirty-three patients (9.06%) were identified with acute neurological complications after heart surgery, including seizures, movement disorders, loss of consciousness, visual disturbances, headache, and hydrocephalus. Conclusion: Improving the implementation of the cardiopulmonary bypass protocols and using neural monitoring for ischemia and bleeding as well as arterial filter during surgery can reduce the incidence of neurological complications after pediatric cardiac surgery.

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Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time

Cited by 30 publications

References 32 publications

Pre- and Postoperative Magnetic Resonance Imaging in Neonatal Arterial Switch Operation Using Warm Perfusion

Pre- and Postoperative Magnetic Resonance Imaging in Neonatal Arterial Switch Operation Using Warm Perfusion

Evaluation of Perfusion Modes on Vital Organ Recovery and Thyroid Hormone Homeostasis in Pediatric Patients Undergoing Cardiopulmonary Bypass

Incidence of Acute Neurologic Complications after Heart Surgery in Children with Congenital Heart Disease

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