Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest.
BACKGROUND
The neurological morbidity associated with prolonged periods of circulatory arrest has led some cardiac surgical teams to promote continuous low-flow cardiopulmonary bypass as an alternative strategy. The nonneurological postoperative effects of both techniques have been previously studied only in a limited fashion.


RESULTS
We compared the hemodynamic profile (cardiac index and systemic and pulmonary vascular resistances), intraoperative and postoperative fluid balance, and perioperative course after deep hypothermia and support consisting predominantly of total circulatory arrest or low-flow cardiopulmonary bypass in a randomized, single-center trial. Eligibility criteria included a diagnosis of transposition of the great arteries and a planned arterial switch operation before the age of 3 months. Of the 171 patients, 129 (66 assigned to circulatory arrest and 63 to low-flow bypass) had an intact ventricular septum and 42 (21 assigned to circulatory arrest and 21 to low-flow bypass) had an associated ventricular septal defect. There were 3 (1.8%) hospital deaths. Patients assigned to low-flow bypass had significantly greater weight gain and positive fluid balance compared with patients assigned to circulatory arrest. Despite the increased weight gain in the infants assigned to low-flow bypass, the duration of mechanical ventilation, stay in the intensive care unit, and hospital stay were similar in both groups. Hemodynamic measurements were made in 122 patients. During the first postoperative night, the cardiac index decreased (32.1 +/- 15.4%, mean +/- SD), while pulmonary and systemic vascular resistance increased. The measured cardiac index was < 2.0 L.min-1.m-2 in 23.8% of the patients, with the lowest measurement typically occurring 9 to 12 hours after surgery. Perfusion strategy assignment was not associated with postoperative hemodynamics or other nonneurological postoperative events.


CONCLUSIONS
After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile.
Wernovsky
G
G
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
Wypij
D
D
Jonas
R A
RA
Mayer
J E
JE
Hanley
F L
FL
Hickey
P R
PR
Walsh
A Z
AZ
Chang
A C
AC
Castañeda
A R
AR
Newburger
J W
JW
Wessel
D L
DL
D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative; D009017:Morbidity; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D011184:Postoperative Period; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*