(Circulation. 1995;92:2226-2235.)
© 1995 American Heart Association, Inc.
Articles |
Postoperative Course and Hemodynamic Profile After the Arterial Switch Operation in Neonates and Infants
A Comparison of Low-Flow Cardiopulmonary Bypass and Circulatory Arrest
Presented in part at the 65th Scientific Sessions of the American Heart Association, November 16-19, 1992, New Orleans, La.
From the Departments of Cardiology (G.W., A.Z.W., A.C.C., J.W.N., D.L.W.), Cardiac Surgery (R.A.J., J.E.M., F.L.H., A.R.C.), and Anesthesia (P.R.H.), Children's Hospital; the Departments of Pediatrics (G.W., A.C.C., J.W.N., D.L.W.), Surgery (R.A.J., J.E.M., F.L.H., A.R.C.), and Anesthesia (P.R.H.), Harvard Medical School; and the Department of Biostatistics (D.W.), Harvard School of Public Health, Boston, Mass.
Background The neurological morbidity associated with prolonged periods of circulatory arrest has led some cardiac surgical teams to promote continuous low-flow cardiopulmonary bypass as an alternative strategy. The nonneurological postoperative effects of both techniques have been previously studied only in a limited fashion.
Methods and Results We compared the hemodynamic profile (cardiac index and systemic and pulmonary vascular resistances), intraoperative and postoperative fluid balance, and perioperative course after deep hypothermia and support consisting predominantly of total circulatory arrest or low-flow cardiopulmonary bypass in a randomized, single-center trial. Eligibility criteria included a diagnosis of transposition of the great arteries and a planned arterial switch operation before the age of 3 months. Of the 171 patients, 129 (66 assigned to circulatory arrest and 63 to low-flow bypass) had an intact ventricular septum and 42 (21 assigned to circulatory arrest and 21 to low-flow bypass) had an associated ventricular septal defect. There were 3 (1.8%) hospital deaths. Patients assigned to low-flow bypass had significantly greater weight gain and positive fluid balance compared with patients assigned to circulatory arrest. Despite the increased weight gain in the infants assigned to low-flow bypass, the duration of mechanical ventilation, stay in the intensive care unit, and hospital stay were similar in both groups. Hemodynamic measurements were made in 122 patients. During the first postoperative night, the cardiac index decreased (32.1±15.4%, mean±SD), while pulmonary and systemic vascular resistance increased. The measured cardiac index was <2.0 L · min-1 · m-2 in 23.8% of the patients, with the lowest measurement typically occurring 9 to 12 hours after surgery. Perfusion strategy assignment was not associated with postoperative hemodynamics or other nonneurological postoperative events.
Conclusions After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile.
Key Words: cardiopulmonary bypass • circulatory arrest • transposition of great vessels • cardiac output • edema
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J. M. Bartlett, D. Wypij, D. C. Bellinger, L. A. Rappaport, L. J. Heffner, R. A. Jonas, and J. W. Newburger Effect of Prenatal Diagnosis on Outcomes in D-Transposition of the Great Arteries Pediatrics, April 1, 2004; 113(4): e335 - e340. [Abstract] [Full Text] [PDF]
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M. Karimi, L. X. Wang, J. M. Hammel, C. E. Mascio, M. Abdulhamid, E. W. Barner, T. D. Scholz, J. L. Segar, W. G. Li, S. D. Niles, et al. Neonatal vulnerability to ischemia and reperfusion: Cardioplegic arrest causes greater myocardial apoptosis in neonatal lambs than in mature lambs J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 490 - 497. [Abstract] [Full Text] [PDF]
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S. M. Cottrell, K. P. Morris, P. Davies, D. C. Bellinger, R. A. Jonas, and J. W. Newburger Early postoperative body temperature and developmental outcome after open heart surgery in infants Ann. Thorac. Surg., January 1, 2004; 77(1): 66 - 71. [Abstract] [Full Text] [PDF]
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C.-H. Yeh, J.-H. S. Pang, Y.-C. Wu, Y.-C. Wang, J.-J. Chu, and P. J. Lin Differential-Display Polymerase Chain Reaction Identifies Nicotinamide Adenine Dinucleotide-Ubiquinone Oxidoreductase as an Ischemia/Reperfusion-Regulated Gene in Cardiomyocytes Chest, January 1, 2004; 125(1): 228 - 235. [Abstract] [Full Text] [PDF]
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D. C. Bellinger, D. Wypij, A. J. duPlessis, L. A. Rappaport, R. A. Jonas, G. Wernovsky, and J. W. Newburger Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1385 - 1396. [Abstract] [Full Text] [PDF]
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V. A. Schroeder, J. M. Pearl, S. M. Schwartz, T. P. Shanley, P. B. Manning, and D. P. Nelson Combined Steroid Treatment for Congenital Heart Surgery Improves Oxygen Delivery and Reduces Postbypass Inflammatory Mediator Expression Circulation, June 10, 2003; 107(22): 2823 - 2828. [Abstract] [Full Text] [PDF]
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T. M. Hoffman, G. Wernovsky, A. M. Atz, T. J. Kulik, D. P. Nelson, A. C. Chang, J. M. Bailey, A. Akbary, J. F. Kocsis, R. Kaczmarek, et al. Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease Circulation, February 25, 2003; 107(7): 996 - 1002. [Abstract] [Full Text] [PDF]
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I. Shen, C. Giacomuzzi, and R. M. Ungerleider Current strategies for optimizing the use of cardiopulmonary bypass in neonates and infants Ann. Thorac. Surg., February 1, 2003; 75(2): S729 - 734. [Abstract] [Full Text] [PDF]
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S M Tibby and I A Murdoch Monitoring cardiac function in intensive care Arch. Dis. Child., January 1, 2003; 88(1): 46 - 52. [Abstract] [Full Text] [PDF]
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H. H. Hovels-Gurich, J. F. Vazquez-Jimenez, A. Silvestri, K. Schumacher, R. Minkenberg, J. Duchateau, B. J. Messmer, G. von Bernuth, and M.-C. Seghaye Production of proinflammatory cytokines and myocardial dysfunction after arterial switch operation in neonates with transposition of the great arteries J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 811 - 820. [Abstract] [Full Text] [PDF]
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P. Tassani, A. Barankay, F. Haas, S. U. Paek, M. Heilmaier, J. Hess, R. Lange, and J. A. Richter Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 648 - 654. [Abstract] [Full Text] [PDF]
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D. P. Nelson, S. Burns Wechsler, T. Miura, A. Stagg, J. W. Newburger, J. E. Mayer Jr, and E. J. Neufeld Myocardial immediate early gene activation after cardiopulmonary bypass with cardiac ischemia-reperfusion Ann. Thorac. Surg., January 1, 2002; 73(1): 156 - 162. [Abstract] [Full Text] [PDF]
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D. Chowdhury, K. Ojamaa, V. A. Parnell, C. McMahon, C. P. Sison, and I. Klein A prospective randomized clinical study of thyroid hormone treatment after operations for complex congenital heart disease J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 1023 - 1025. [Full Text] [PDF]
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U. Kiziltepe, A. Uysalel, T. Corapcioglu, K. Dalva, H. Akan, and H. Akalin Effects of combined conventional and modified ultrafiltration in adult patients Ann. Thorac. Surg., February 1, 2001; 71(2): 684 - 693. [Abstract] [Full Text] [PDF]
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M. Nagashima, Y. Imai, K. Seo, M. Terada, M. Aoki, T. Shin'oka, and M. Koide Effect of hemofiltrated whole blood pump priming on hemodynamics and respiratory function after the arterial switch operation in neonates Ann. Thorac. Surg., December 1, 2000; 70(6): 1901 - 1906. [Abstract] [Full Text] [PDF]
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R. M. Ungerleider Role for deep hypothermic circulatory arrest during repair of heart defects in infants J. Thorac. Cardiovasc. Surg., August 1, 2000; 120(2): 425 - 426. [Full Text] [PDF]
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L. L. Lequier, H. Nikaidoh, S. R. Leonard, J. L. Bokovoy, M. L. White, P. J. Scannon, and B. P. Giroir Preoperative and Postoperative Endotoxemia in Children With Congenital Heart Disease Chest, June 1, 2000; 117(6): 1706 - 1712. [Abstract] [Full Text] [PDF]
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U. Dyamenahalli, B. W. McCrindle, G. A. Barker, W. G. Williams, R. M. Freedom, and D. J. Bohn Influence of perioperative factors on outcomes in children younger than 18 months after repair of tetralogy of Fallot Ann. Thorac. Surg., April 1, 2000; 69(4): 1236 - 1242. [Abstract] [Full Text] [PDF]
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R R Chaturvedi, V E Hjortdal, E V Stenbog, H B Ravn, P White, T D Christensen, A B Thomsen, J Pedersen, K E Sorensen, and A N Redington Inhibition of nitric oxide synthesis improves left ventricular contractility in neonatal pigs late after cardiopulmonary bypass Heart, December 1, 1999; 82(6): 740 - 744. [Abstract] [Full Text]
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E. B. Rosenzweig, T. J. Starc, J. M. Chen, S. Cullinane, D. M. Timchak, W. M. Gersony, D. W. Landry, and M. E. Galantowicz Intravenous Arginine-Vasopressin in Children With Vasodilatory Shock After Cardiac Surgery Circulation, November 9, 1999; 100 (2009): II-182 - II-186. [Abstract] [Full Text] [PDF]
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J. F. Rhodes, A. D. Blaufox, H. S. Seiden, J. D. Asnes, R. P. Gross, J. P. Rhodes, R. B. Griepp, and A. F. Rossi Cardiac Arrest in Infants After Congenital Heart Surgery Circulation, November 9, 1999; 100 (2009): II-194 - II-199. [Abstract] [Full Text] [PDF]
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C. Metais, J. Li, J. Li, M. Simons, and F. W. Sellke Serotonin-Induced Coronary Contraction Increases After Blood Cardioplegia-Reperfusion : Role of COX-2 Expression Circulation, November 9, 1999; 100 (2009): II-328 - II-334. [Abstract] [Full Text] [PDF]
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R. Hirsch, C. L. Dent, M. K. Wood, C. B. Huddleston, E. N. Mendeloff, D. T. Balzer, Y. Landt, C. A. Parvin, M. Landt, J. H. Ladenson, et al. Patterns and Potential Value of Cardiac Troponin I Elevations After Pediatric Cardiac Operations Ann. Thorac. Surg., May 1, 1998; 65(5): 1394 - 1399. [Abstract] [Full Text] [PDF]
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M. J. Davies, K. Nguyen, J. W. Gaynor, M. J. Elliott, and M. R. de Leval Modified Ultrafiltration Improves Left Ventricular Systolic Function In Infants After Cardiopulmonary Bypass J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 361 - 370. [Abstract] [Full Text] [PDF]
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R. R. Chaturvedi, C. Lincoln, J. W. W. Gothard, M. H. Scallan, P. A. White, A. N. Redington, and D. F. Shore Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: Quantitation with the use of a conductance catheter immediately after bypass J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 77 - 83. [Abstract] [Full Text] [PDF]
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