Usefulness of low-priming-volume cardiopulmonary bypass circuits and dilutional ultrafiltration in neonatal open-heart surgery.
In neonate open-heart surgery, cardiopulmonary bypass (CPB) with extreme hemodilution induces an increased capillary permeability and accumulation of extravascular fluid, resulting in organ dysfunction. We evaluated the effects of a reduced priming volume for CPB and dilutional ultrafiltration (DUF) during neonatal open-heart surgery. Nineteen consecutive neonates with complete transposition of the great arteries who underwent an arterial switch operation were retrospectively assigned into two groups: the high-priming-volume circuit group (group A, n = 9) and the low-priming-volume circuit group (group B, n = 10). Patients in group B underwent surgery with a miniaturized CPB circuit and using the DUF technique. The priming volume of group B was nearly two-thirds that of group A. The water balance value after CPB and surgery was significantly lower in group B (-126 +/- 118 ml, -116 +/- 116 ml) than in group A (88 +/- 218 ml, 83 +/- 165 ml). Systolic blood pressure just after CPB was higher in group B (67.9 +/- 9.1 mmHg) than in group A (55.4 +/- 10.3 mmHg). Postoperative ventilatory support was shorter in group B (45 +/- 19 h) than in group A (68 +/- 27 h). In neonatal cardiac surgery, low-priming-volume CPB circuits and DUF improve the water balance during surgery and may attenuate any inflammatory reaction, which would help preserve postoperative organ function.
Fukumura
Fumio
F
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan. ffukumurah1@aih-net.com
Kado
Hideaki
H
Imoto
Yutaka
Y
Shiokawa
Yuichi
Y
Minami
Kazu
K
Murakami
Jun
J
Yasui
Hisataka
H
D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D006438:Hemodilution; D006801:Humans; D007231:Infant, Newborn; D012121:Respiration, Artificial; D014188:Transposition of Great Vessels / Q000601:surgery; D014462:Ultrafiltration