Recent advancements in pediatric cardiopulmonary bypass technology for better outcomes of pediatric cardiac surgery

Abstract

Background Pediatric cardiac surgery is in itself very enigmatic and individualized. Presently, there has been a slew of new developments aimed primarily toward pediatric cardiopulmonary bypass for safer, patient-centered pediatric cardiac surgery. Still, lot of technological challenges need to be resolved, and their safer application in pediatric and neonate patients requires further refinement. Main body of the abstract Considering various significant yet unresolved issues of pediatric cardiac bypass, an exhaustive literature search was done on various internet databases with standard keywords. There are various new recent improvements; as the first oxygenator explicitly designed for neonatal patients; pediatric oxygenators with low prime volumes and surface areas that allow flows up to 2 L/min; pediatric oxygenators with integrated arterial filters; and miniature ultrafiltration devices that allow for high rates of ultrafiltrate removal. These advancements can significantly reduce cardiopulmonary bypass circuit surface areas and prime volumes. These advancements could reduce or eliminate the requirement for homologous red blood cells during or after surgery with reduction or eliminate bypass-related hemodilution, and inflammation. Because of the immaturity of the neonatal hemostatic system, conventional coagulation tests alone are insufficient to guide neonatal hemostatic therapy. Myocardial preservation techniques, safe temperature with duration are still debatable and yet to be fully explored. Short conclusion This review is based on Standards for Quality Improvement Reporting Excellence guidelines to provide a framework for reporting new knowledge to find better management strategy for pediatric cardiac cases.

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

“…MUF also minimizes bleeding and increases hemoconcentration in patients after CPB [18]. The CPB in pediatric patients is associated with post-procedural inflammation due to several predominant factors, including hypothermia (extreme degrees), the requirement for complex procedures, prolonged bypass times, hemodilution, and body mass [19]. A significant decline in pulmonary function due to CPB is the result of the inflammatory responses, leading to delays in ICU discharge, prolonged extubation, and disrupted cardiopulmonary interactions [20].…”