Strategies for repair of congenital heart defects in infants without the use of blood.
Eleven infants and children with a body weight of less than 10 kg (median weight, 6.8 kg) whose parents were Jehovah's Witnesses underwent repair (n = 10) or palliation (n = 1) of congenital heart defects without the use of blood products and with (n = 9) or without (n = 2) cardiopulmonary bypass (CPB). In 1 neonate (weight, 3.2 kg) with critical aortic stenosis, moderate hypothermia and a 3.5-minute period of inflow occlusion and circulatory arrest allowed an aortic valvotomy; in another patient (weight, 7.0 kg) with tricuspid and pulmonary atresia, transposition of the great arteries, and persistent left superior vena cava, a bilateral bidirectional cavopulmonary shunt procedure was performed without CPB. Use of heparin-bonded tubing allowed reduction of the initial dose of heparin sodium to 1 mg/kg. Tissue perfusion and oxygenation on bypass were adequate, as evidenced by a mean lowest pH of 7.38 +/- 0.09 and a mean lowest venous oxygen tension of 65.0 +/- 36.2 mm Hg. Although the mean postoperative hematocrit (Hct) was lower than the mean preoperative Hct (p < 0.05, analysis of variance and Scheffe's F test), the Hct within 2 hours after CPB was restored to a value (mean Hct, 27.5% +/- 1.0%) between the preoperative Hct (mean value, 42.7% +/- 3.5%) and the lowest Hct on CPB (mean value, 18.4% +/- 1.4%). The Hct at discharge was 31.8% +/- 1.1%. The median postoperative blood loss was 9 mL/kg. There was no perioperative mortality. The median stay in the intensive care unit and the hospital was 2 days and 6 days, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
van Son
J A
JA
Albert Starr Academic Center for Cardiac Surgery, St. Vincent Hospital and Medical Center, Portland, Oregon.
Hovaguimian
H
H
Rao
I M
IM
He
G W
GW
Meiling
G A
GA
King
D H
DH
Starr
A
A
D016063:Blood Loss, Surgical; D001835:Body Weight; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D002835:Christianity; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008722:Methods; D010166:Palliative Care