Usefulness of low-priming-volume cardiopulmonary bypass circuits and dilutional ultrafiltration in neonatal open-heart surgery

Fukumura, Fumio; Kado, Hideaki; Imoto, Yutaka; Shiokawa, Yoshiaki; Minami, K; Murakami, Jun; Yasui, Hirofumi

doi:10.1007/s10047-003-0241-9

Cited by 15 publications

(8 citation statements)

References 7 publications

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“…During CPB, we frequently applied ultrafiltration to concentrate the circuit fluid. We believe that vigorous ultrafiltration is essential for the reduction of transfusion during CPB .…”

Section: Discussionmentioning

confidence: 99%

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

et al. 2013

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Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). In the MP group, narrow-caliber (3/16″) tubing was used, and the pump heads were vertically aligned to shorten the tubing lengths. The smallest possible oxygenators and hemofilters were used, and vacuum drainage was applied. Ultrafiltration was vigorously applied during CPB to avoid excessive hemodilution. The mean age and body weight of the patients were 48 ± 41 (0-306) days and 3.8 ± 0.8 (1.3-5.0) kg, respectively. The total priming and transfusion volumes during CPB were lower in the MP group than in the CP group (141 ± 24 mL vs. 292 ± 50 mL, P< 0.001, and 82 ± 40 mL vs. 162 ± 82 mL, P < 0.001, respectively). In the MP group, the smallest priming volume was 110 mL. However, there was no significant difference in the lowest hematocrit level during CPB between the two groups (22 ± 3% vs. 22 ± 3%, P = 0.724). The incidence of postoperative neurological complications was not significantly different between the MP and CP groups (1.8% vs. 2.7%, P = 0.509). After adjustment for the Risk Adjustment for Congenital Heart Surgery category, body surface area, and age, MP was not an independent risk factor of postoperative neurological complications or early mortality (P = 0.213 and P = 0.467, respectively). The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.

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“…During CPB, we frequently applied ultrafiltration to concentrate the circuit fluid. We believe that vigorous ultrafiltration is essential for the reduction of transfusion during CPB .…”

Section: Discussionmentioning

confidence: 99%

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

et al. 2013

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“…It was recently shown that low-prime volumes of CPB for neonatal cardiac surgery improve water balance during surgery and preserve postoperative organ function [15]. Meanwhile, recent papers indicate that higher haematocrit levels during CPB were associated with reduction in adverse perioperative and postoperative outcomes (haematocrit levels of 30% compared with 20%) [16].…”

Section: Discussionmentioning

confidence: 99%

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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“…It was recently shown that low-priming CPB circuits in neonatal cardiac surgery improve water balance during surgery and preserve postoperative organ function [19]. The small priming volume allowed us to adjust hemodilution to a hematocrit of approximately 25% during CPB without additional blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Moderate versus deep hypothermia for the arterial switch operation — experience with 100 consecutive patients

Rastan

Walther

Alam

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Usefulness of low-priming-volume cardiopulmonary bypass circuits and dilutional ultrafiltration in neonatal open-heart surgery

Cited by 15 publications

References 7 publications

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

Five‐Year Experience With Mini‐Volume Priming in Infants ≤5 kg: Safety of Significantly Smaller Transfusion Volumes

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

Moderate versus deep hypothermia for the arterial switch operation — experience with 100 consecutive patients

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