Low antithrombin levels in neonates and infants undergoing congenital heart surgery result in more red blood cell and plasma transfusion on cardiopulmonary bypass

Transfusion ◽  
2020 ◽  
Vol 60 (12) ◽  
pp. 2841-2848
Author(s):  
Zhe Amy Fang ◽  
Karen Bruzdoski ◽  
Vadim Kostousov ◽  
Shiu‐Ki Rocky Hui ◽  
David Vener ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Plasma Transfusion ◽  
Blood Cell And Plasma ◽  
Neonates And Infants

Post-operative kinetics of C-reactive protein to distinguish between bacterial infection and systemic inflammation in infants after cardiopulmonary bypass surgery: the early and the late period

2021 ◽  
pp. 1-8
Author(s):  
Hanna Renk ◽  
David Grosse ◽  
Sarah Schober ◽  
Christian Schlensak ◽  
Michael Hofbeck ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bacterial Infection ◽  
Congenital Heart ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Post Operative Period ◽  
Kinetics Of

Abstract Objectives: Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0–4) and late (days 5–28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. Methods: This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. Results: We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64–22.02) and 6.92 mg/dl (1.92–19.65) on days 2 and 3 compared to 4.02 (1.99–15.9) and 3.72 mg/dl (1.08–9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. Conclusions: In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

scholarly journals Treatment of systemic inflammatory response syndrome following on-pump pediatric congenital heart surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 113-124
Author(s):  
D. V. Borisenko ◽  
A. A. Ivkin ◽  
D. L. Shukevich
Keyword(s):  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Surgical Techniques ◽  
Congenital Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Preventive Strategies

Highlights. The article discusses the pathophysiological aspects of cardiopulmonary bypass and the mechanisms underlying the development of the systemic inflammatory response in children following congenital heart surgery. We summarize and report the most relevant preventive strategies aimed at reducing the systemic inflammatory response, including both, CPB-related methods and pharmacological ones.The growing number of children with congenital heart defects requires the development of more advanced technologies for their surgical treatment. However, cardiopulmonary bypass is required in almost all surgical techniques. Despite the tremendous progress and recent advances in cardiopulmonary bypass techniques, the systemic inflammatory response syndrome associated with these surgeries remains unresolved. The review summarizes the causes and mechanisms underlying its development. The most commonly used preventive strategies are reported, including standard and modified ultrafiltration, leukocyte filters, and pharmacological agents (systemic glucocorticoids, aprotinin, and antioxidants).The role of cardioplegia and hypothermia in the reduction of systemic inflammation is defined. Cardiac surgery centers around the world use a variety of techniques and pharmacological approaches, drawing on the results of randomized clinical studies. However, there are no clear and definite clinical guidelines aimed at reducing the systemic inflammatory response during cardiopulmonary bypass in children. It remains a significant problem for pediatric intensive care by aggravating their postoperative status, prolonging the length of the in-hospital stay, and reducing the survival rates.

The Correlation of Two Cerebral Saturation Monitors With Jugular Bulb Oxygen Saturation in Children Undergoing Cardiopulmonary Bypass for Congenital Heart Surgery

2016 ◽  
Vol 32 (10) ◽  
pp. 603-608 ◽  
Author(s):  
Aymen N. Naguib ◽  
Peter D. Winch ◽  
Roby Sebastian ◽  
Daniel Gomez ◽  
Luisa Guzman ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Near Infrared ◽  
Jugular Bulb ◽  
Congenital Heart Surgery ◽  
Cerebral Oxygen ◽  
Cerebral Saturation

Background: Near-infrared spectroscopy (NIRS) is a noninvasive monitoring technique that measures regional cerebral oxygen saturation (rSO2). Objectives: The primary aim was to compare the output of 2 NIRS-based cerebral oximetry devices, FORESIGHT (CAS Medical Systems Inc, Branford, Connecticut) and INVOS (Covidien, Boulder, Colorado), to venous oxygen saturations from the jugular venous bulb at cannulation and decannulation of the superior vena cava (SVC). Secondary objectives included evaluating correlations of cerebral saturation, as measured by the NIRS devices, with mean arterial blood pressure (MAP), measured by an invasive arterial line, and end-tidal CO2 (ETCO2). Methods: Near-infrared spectroscopy, MAP, and ETCO2 data were collected at 13 defined events during each case when hemodynamic instability was expected. At SVC cannulation and decannulation, a 0.1 mL sample of blood was collected from the jugular bulb by the surgeon using a long angiocatheter. The oxygen saturation of these blood samples was measured using an AVOX device and compared with contemporaneous readings from the NIRS probes. Mixed-effects linear regression was used to correlate MAP or ETCO2 with cerebral oxygen saturation (by NIRS) at each time point. Results: Children undergoing cardiopulmonary bypass for congenital heart surgery (n = 34) were enrolled in the study. At SVC cannulation, both INVOS ( r = .78) and FORESIGHT ( r = .59) were correlated with AVOX data at P < .001, although the correlation with INVOS was significantly stronger ( P = .003). At SVC decannulation, INVOS ( r = .68; P < .001) and FORESIGHT ( r = .60; P < .001) were similarly correlated with jugular venous rSO2. Correlations of rSO2 (by NIRS) with MAP and ETCO2 levels were stronger than correlations between rSO2 change and change in MAP or ETCO2. Conclusion: INVOS correlated more strongly than FORESIGHT with the jugular bulb rSO2 at SVC cannulation but may have underestimated oxygen saturation at low rSO2 values. Data from both NIRS devices were correlated with MAP and ETCO2 over the case duration.

Audit of transfusion of blood products in paediatric congenital heart surgery on cardiopulmonary bypass

2018 ◽  
Vol 29 (6) ◽  
pp. 381-386
Author(s):  
Caroline Tumelo Bayebaye ◽  
Michel Kasongo Muteba ◽  
Palesa Motshabi Chakane
Keyword(s):  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Blood Products

Pharmacokinetic Comparison of Cisatracurium and Vecuronium Infusions in Neonates and Infants Following Congenital Heart Surgery

2002 ◽  
Vol 96 (Sup 2) ◽  
pp. A1013 ◽  
Author(s):  
David L. Reich ◽  
Ingrid Hollinger ◽  
Donna J. Harrington ◽  
Ryan D. Cook
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Neonates And Infants

scholarly journals Comparison of Early Outcomes for Normothermic and Hypothermic Cardiopulmonary Bypass in Children Undergoing Congenital Heart Surgery

2018 ◽  
Vol 6 ◽  
Author(s):  
Antonio F. Corno ◽  
Claire Bostock ◽  
Simon D. Chiles ◽  
Joanna Wright ◽  
Maria-Teresa Jn Tala ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Hypothermic Cardiopulmonary Bypass

Cardiopulmonary Bypass through a Left Thoracotomy Using Venous Drainage from the Innominate Vein in Congenital Heart Surgery

2013 ◽  
Vol 28 (5) ◽  
pp. 591-594 ◽  
Author(s):  
Takaaki Suzuki ◽  
Ayumu Masuoka ◽  
Yoshimasa Uno ◽  
Mika Iwazaki ◽  
Syunsuke Yamagishi ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Venous Drainage ◽  
Congenital Heart Surgery ◽  
Innominate Vein ◽  
Left Thoracotomy

Continuous positive airway pressure and lung separation during cardiopulmonary bypass to facilitate congenital heart surgery via the right thorax in children

2007 ◽  
Vol 17 (7) ◽  
pp. 693-696 ◽  
Author(s):  
ALEXANDER J.C. MITTNACHT ◽  
UMESH JOASHI ◽  
KHANH NGUYEN ◽  
CYNTHIA CHIN ◽  
SHUBHIKA SRIVASTAVA ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Positive Airway Pressure ◽  
Congenital Heart Surgery ◽  
The Right

Alternative strategies in newborns and infants with major co-morbidities to improve congenital heart surgery outcomes at an emerging programme

2015 ◽  
Vol 26 (3) ◽  
pp. 485-492 ◽  
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami ◽  
Jarrod D. Knudson ◽  
Samantha R. Seals ◽  
Avichal Aggarwal ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Surgical Strategies ◽  
Prolonged Intubation ◽  
Co Morbidity ◽  
Neonates And Infants

AbstractIntroductionDebilitating patient-related non-cardiac co-morbidity cumulatively increases risk for congenital heart surgery. At our emerging programme, flexible surgical strategies were used in high-risk neonates and infants generally considered in-operable, in an attempt to make them surgical candidates and achieve excellent outcomes.Materials and methodsBetween April, 2010 and November, 2013, all referred neonates (142) and infants (300) (average scores: RACHS 2.8 and STAT 3.0) underwent 442 primary cardiac operations: patients with bi-ventricular lesions underwent standard (n=294) or alternative (n=19) repair/staging strategies, such as pulmonary artery banding(s), ductal stenting, right outflow patching, etc. Patients with uni-ventricular hearts followed standard (n=96) or alternative hybrid (n=34) staging. The impact of major pre-operative risk factors (37%), standard or alternative surgical strategy, prematurity (50%), gestational age, low birth weight, genetic syndromes (23%), and major non-cardiac co-morbidity requiring same admission surgery (27%) was analysed on the need for extracorporeal membrane oxygenation, mortality, length of intubation, as well as ICU and hospital length of stays.ResultsThe need for extracorporeal membrane oxygenation (8%) and hospital survival (94%) varied significantly between surgical strategy groups (p=0.0083 and 0.028, respectively). In high-risk patients, alternative bi- and uni-ventricular strategies minimised mortality, but were associated with prolonged intubation and ICU stay. Major pre-operative risk factors and lower weight at surgery significantly correlated with prolonged intubation, hospital length of stay, and mortality.DiscussionIn our emerging programme, flexible surgical strategies were offered to 53/442 high-risk neonates and infants with complex CHDs and significant non-cardiac co-morbidity, in order to buffer risk and achieve patient survival, although at the cost of increased resource utilisation.

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