Miniaturized biocompatible cardiopulmonary bypass for the Fontan procedure.
OBJECTIVE
Postoperative inflammatory response and perioperative systemic edema are the risks of failed Fontan circulation. We evaluated the efficiency of the miniaturized, poly-2-methoxyethylacrylate (PMEA)-coated cardiopulmonary bypass (CPB) circuit, which we devised in 2003, in the Fontan circulation.


METHODS
Thirty-seven patients who underwent the Fontan procedure between March 1996 and December 2006 were divided into two groups: one consisting of patients with a priming-volume >250 m on uncoated conventional bypass (group C; n = 20), and one consisting of those with miniaturized (<200 ml) and PMEA-coated circuits (group M; n = 17). We compared the body weight gain (%BWG), minimum platelet count, maximum postoperative C-reactive protein (CRP), and minimum hematocrit (Hct) levels during the operation, maximum white blood cell (WBC) count, and postoperative pleural effusion, between the two groups. Stepwise multiple logistic regression analyses were used to investigate the most affecting factors.


RESULTS
The %BWG and CRP levels were significantly lower in group M (P = 0.047 and P = 0.012, respectively). The minimum platelet count was significantly higher in group M (P = 0.012). There were no significant differences in postoperative pleural effusion, minimum Hct, or maximum WBC.


CONCLUSIONS
The miniaturized biocompatible CPB system reduced perioperative inflammatory responses.
Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 225-8555, Japan.
Keiichi
K
Itatani
Kagami
K
Miyaji
Takashi
T
Miyamoto
Nobuyuki
N
Inoue
Takahiro
T
Tomoyasu
Satoshi
S
Kohira
Hajime
H
Sato
Kuniyoshi
K
Ohara
D000179:Acrylates / Q000737:chemistry*; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D004487:Edema / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control*; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D059035:Perioperative Period; D010976:Platelet Count; D011108:Polymers / Q000737:chemistry*; D011446:Prospective Studies
D000179:Acrylates; D020099:Coated Materials, Biocompatible; D011108:Polymers; C413485:poly(2-methoxyethylacrylate); D002097:C-Reactive Protein