title: Perioperative effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants.
abstract: OBJECTIVE
  In a randomized, single-center trial, we compared perioperative outcomes in infants undergoing cardiac operations after use of the alpha-stat versus pH-stat strategy during deep hypothermic cardiopulmonary bypass.
  
  
  METHODS
  Admission criteria included reparative cardiac surgery, age less than 9 months, birth weight 2.25 kg or more, and absence of associated congenital or acquired extracardiac disorders.
  
  
  RESULTS
  Among the 182 infants in the study, diagnoses included D-transposition of the great arteries (n = 92), tetralogy of Fallot (n = 50), tetralogy of Fallot with pulmonary atresia (n = 6), ventricular septal defect (n = 20), truncus arteriosus (n = 8), complete atrioventricular canal (n = 4), and total anomalous pulmonary venous return (n = 2). Ninety patients were assigned to alpha-stat and 92 to pH-stat strategy. Early death occurred in four infants (2%), all in the alpha-stat group (p = 0.058). Postoperative electroencephalographic seizures occurred in five of 57 patients (9%) assigned to alpha-stat and one of 59 patients (2%) assigned to pH-stat strategy (p = 0.11). Clinical seizures occurred in four infants in the alpha-stat group (4%) and two infants in the pH-stat group (2%) (p = 0.44). First electroencephalographic activity returned sooner among infants randomized to pH-stat strategy (p = 0.03). Within the homogeneous D-transposition subgroup, those assigned to pH-stat tended to have a higher cardiac index despite a lower requirement for inotropic agents; less frequent postoperative acidosis (p = 0.02) and hypotension (p = 0.05); and shorter duration of mechanical ventilation (p = 0.01) and intensive care unit stay (p = 0.01).
  
  
  CONCLUSIONS
  Use of the pH-stat strategy in infants undergoing deep hypothermic cardiopulmonary bypass was associated with lower postoperative morbidity, shorter recovery time to first electroencephalographic activity, and, in patients with D-transposition, shorter duration of intubation and intensive care unit stay. These data challenge the notion that alpha-stat management is a superior strategy for organ protection during reparative operations in infants using deep hypothermic cardiopulmonary bypass.
authors.affiliation: Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: du Plessis
authors.forename: R A
authors.initials: RA
authors.lastname: Jonas
authors.forename: D
authors.initials: D
authors.lastname: Wypij
authors.forename: P R
authors.initials: PR
authors.lastname: Hickey
authors.forename: J
authors.initials: J
authors.lastname: Riviello
authors.forename: D L
authors.initials: DL
authors.lastname: Wessel
authors.forename: S J
authors.initials: SJ
authors.lastname: Roth
authors.forename: F A
authors.initials: FA
authors.lastname: Burrows
authors.forename: G
authors.initials: G
authors.lastname: Walter
authors.forename: D M
authors.initials: DM
authors.lastname: Farrell
authors.forename: A Z
authors.initials: AZ
authors.lastname: Walsh
authors.forename: C A
authors.initials: CA
authors.lastname: Plumb
authors.forename: P
authors.initials: P
authors.lastname: del Nido
authors.forename: R P
authors.initials: RP
authors.lastname: Burke
authors.forename: A R
authors.initials: AR
authors.lastname: Castaneda
authors.forename: J E
authors.initials: JE
authors.lastname: Mayer
authors.forename: J W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D000136:Acid-Base Equilibrium; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004569:Electroencephalography; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012640:Seizures / Q000517:prevention & control