The benefits of high-flow management in children with pulmonary atresia.
The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.
Fujii
Yasuhiro
Y
Department of Cardiovascular Surgery, Okayama University Hospital, Okayama-city, Okayama, Japan. gze00572@nifty.ne.jp
Kotani
Yasuhiro
Y
Kawabata
Takuya
T
Ugaki
Shinya
S
Sakurai
Shigeru
S
Ebishima
Hironori
H
Itoh
Hideshi
H
Nakakura
Mahito
M
Arai
Sadahiko
S
Kasahara
Shingo
S
Sano
Shunji
S
Iwasaki
Tatsuo
T
Toda
Yuichiro
Y
D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010100:Oxygen / Q000378:metabolism; D018633:Pulmonary Atresia / Q000601:surgery* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D019344:Lactic Acid; D010100:Oxygen