Conventional cardiopulmonary bypass in neonates. A physiological approach -10 years of experience at Marie-Lannelongue Hospital

There is still controversy about the optimal method of venoarterial cardiopulmonary bypass (CPB) for correction of congenital heart diseases in neonates and young infants. High rates of CPB-related morbidity and mortality are still reported. Since 1980, conventional CPB with double caval cannulation with right-angled cannulae has been used in the high majority of neonates at Marie-Lannelongue Hospital. The extracorporeal circuit was miniaturized to be primed with a volume as small as possible. Priming (500 ml) was done with packed red cells and fresh frozen plasma. CPB was conducted at 30% haematocrit and normal ranges of flow rate, arterial pressure, systemic vascular resistances and oxygen delivery. These normal physiological parameters were also maintained during hypothermia. During the last two years, 151 neonates below 15 days old who underwent open-heart surgery were reviewed. The overall hospital mortality was 7.24%. None of the survivors had postoperative complications related to CPB. All physiological and biological values remained within normal ranges during the postoperative course.

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10 / Comparison of Fresh Frozen Plasma (FFP) and Plasmalyte® for priming cardiopulmonary bypass in infants and children undergoing open-heart surgery: A double-blinded, randomised study.

10.26226/morressier.5aeb0ac807b0d6001a79a5b1 ◽

2018 ◽

Author(s):

Audrey Dieu ◽

Audrey ['Mona']

Keyword(s):

Cardiopulmonary Bypass ◽

Heart Surgery ◽

Open Heart Surgery ◽

Fresh Frozen Plasma ◽

Open Heart ◽

Randomised Study ◽

Fresh Frozen ◽

Double Blinded ◽

Frozen Plasma ◽

In Infants And Children

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The Role of Thromboelastography in Directing Blood Product Usage in Infant Open Heart Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181bbd4ff ◽

2009 ◽

Vol 4 (5) ◽

pp. 282-290 ◽

Cited By ~ 8

Author(s):

Eric N. Mendeloff ◽

George F. Glenn ◽

Paul Tavakolian ◽

Eugene Lin ◽

Allison Leonard ◽

...

Keyword(s):

Heart Surgery ◽

Blood Product ◽

Open Heart Surgery ◽

Fresh Frozen Plasma ◽

Blood Component ◽

Open Heart ◽

Product Usage ◽

Blood Component Therapy ◽

Fresh Frozen

Objective Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery. Methods TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG). Results Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group. TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients. Conclusions TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.

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Cardiopulmonary Bypass Strategy to Facilitate Transfusion-Free Congenital Heart Surgery in Neonates and Infants

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1700529 ◽

2019 ◽

Vol 68 (01) ◽

pp. 002-014 ◽

Cited By ~ 1

Author(s):

Wolfgang Boettcher ◽

Frank Dehmel ◽

Mathias Redlin ◽

Nicodème Sinzobahamvya ◽

Joachim Photiadis

Keyword(s):

Cardiopulmonary Bypass ◽

Extracorporeal Circulation ◽

Heart Surgery ◽

Mild Hypothermia ◽

Open Heart Surgery ◽

Primary Circuit ◽

Open Heart ◽

Young Infants ◽

Low Weight ◽

Neonates And Infants

AbstractPriming the cardiopulmonary bypass (CPB) circuit without the addition of homologous blood constitutes the basis of blood-saving strategies in open-heart surgery. For low-weight patients, in particular neonates and infants, this implies avoidance of excessive hemodilution during extracorporeal circulation. The circuit has to be miniaturized and tubing must be cut as short as possible to reduce the priming volume to prevent unacceptable hemodilution with initiating CPB. During perfusion, measures should be taken to prevent blood loss from the primary circuit to avoid replacement by additional volume. Favorable factors such as mild hypothermia/normothermia and high heparin concentrations during extracorporeal circulation promote earlier hemostasis after coming off bypass.Lower mortality score, first chest entry, higher hemoglobin concentration before going on bypass, and shorter CPB duration support transfusion-free CPB procedure. Reduced postoperative morbidity and mortality were observed when CPB was performed without blood transfusion. In our experience, this can be achieved in at least 70% of CPBs, even in low-weight patients.Bloodless CPB circuit priming should become a widespread reality, even in neonates and young infants, in any open-heart procedure.

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Universal fresh frozen plasma (Uniplas): a safe product in open-heart surgery

Intensive Care Medicine ◽

10.1007/s00134-003-1952-3 ◽

2003 ◽

Vol 29 (10) ◽

pp. 1736-1743 ◽

Cited By ~ 25

Author(s):

Stein Tølløfsrud ◽

Harald Noddeland ◽

Jan Ludvig Svennevig ◽

Gunnar Bentsen ◽

Tom Eirik Mollnes ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Fresh Frozen Plasma ◽

Open Heart ◽

Safe Product ◽

Fresh Frozen ◽

Frozen Plasma

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Effects of solvent/detergent-treated plasma and fresh-frozen plasma on haemostasis and fibrinolysis in complex coagulopathy following open-heart surgery

Vox Sanguinis ◽

10.1046/j.1423-0410.2002.00129.x ◽

2002 ◽

Vol 82 (1) ◽

pp. 9-14 ◽

Cited By ~ 46

Author(s):

H. Haubelt ◽

M. Blome ◽

A. H. Kiessling ◽

F. Isgro ◽

J. Bach ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Fresh Frozen Plasma ◽

Open Heart ◽

Fresh Frozen ◽

Frozen Plasma

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Exploration to the Application of Hybird Technology in Special Types of Congenital Heart Diseases in Children

10.21203/rs.3.rs-38985/v1 ◽

2020 ◽

Author(s):

Yuhang Liu ◽

Ning Wang ◽

Ping Wen

Keyword(s):

Cardiopulmonary Bypass ◽

Surgical Treatment ◽

Right Ventricular ◽

Heart Surgery ◽

Heart Diseases ◽

Open Heart Surgery ◽

Pulmonary Atresia ◽

Right Ventricular Outflow Tract ◽

Aortopulmonary Window ◽

Hybrid Technology

Abstract Background Hybrid technology has become a hot topic in cardiovascular surgery,has been widely used in the minimally invasive closure of simple coronary heart diseases (CHDs). For some children with special CHDs, it is still impossible to avoid the huge trauma caused by cardiopulmonary bypass. This study aimed to investigate the feasibility、safety and efficacy of hybrid technology in the treatment of several specific CHDs. Methods A total of 29 children with specific CHDs hospitalised in the Cardiac Surgery Department of Dalian Children’s Hospital from July 2014 to June 2019 were enrolled. There were 2 cases of right coronary artery-right ventricular fistula, 17 cases of neonatal critical pulmonary stenosis (CPS), 9 cases of neonatal pulmonary atresia-intact ventricular septum (PA/IVS), and 1 case of giant aortopulmonary window (APW). All of them underwent surgical treatment with hybrid technology guided by transoesophageal echocardiography (TEE). The TEE enabled immediate evaluation of the surgical curative effect. Further chest X-ray, electrocardiogram (ECG) and echocardiogram were performed in the outpatient department after discharge. Results The surgical treatment with hybrid technology was smooth except that 1 CPS patient was converted to open-heart surgery with cardiopulmonary bypass (CPB) due to a torn right ventricular outflow tract after balloon dilatation. No complication, such as wound or intracardiac infection, arrhythmia or pericardial effusion occurred. No children have been lost to follow-up and the investigation results and prognosis remain satisfactory. Conclusions the use of hybrid technology is a safe and effective alternative therapy for specific paediatric CHD cases. It has significant advantages in alleviating trauma and reducing medical costs and, therefore, has good prospects for broad application in the future.

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A Case of Postoperative Lung Injury Requiring a Large Amount of Fresh Frozen Plasma to Achieve Hemostasis during Open-heart Surgery

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA ◽

10.2199/jjsca.36.297 ◽

2016 ◽

Vol 36 (3) ◽

pp. 297-304

Author(s):

Keiko OKAMURA ◽

Junko ICHIKAWA ◽

Mitsuharu KODAKA ◽

Goro KANEKO ◽

Mariko ONO ◽

...

Keyword(s):

Lung Injury ◽

Heart Surgery ◽

Open Heart Surgery ◽

Fresh Frozen Plasma ◽

Open Heart ◽

Fresh Frozen ◽

Frozen Plasma

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Cardiac Surgery Under Cardiopulmonary Bypass in Pregnancy: Report of Four Cases

10.21203/rs.3.rs-687143/v1 ◽

2021 ◽

Author(s):

Youhao You ◽

Shenghua Liu ◽

Zhaohong Wu ◽

Dunjin Chen ◽

Gefei Wang ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Pregnant Women ◽

Valve Replacement ◽

Heart Valve ◽

Heart Surgery ◽

Heart Diseases ◽

Open Heart Surgery ◽

First Choice ◽

Mother And Child ◽

At Home

Abstract Background: Open heart surgery during pregnancy is relatively rare at home and abroad, with high risk and high probability of maternal and infant death. How to carry out heart valve replacement under cardiopulmonary bypass (CPB) under the condition of ensuring the safety of mother and child is a focus of attention at home and abroad. Case introduction: We reported four cases of pregnant women who underwent cardiac surgeries under CPB during pregnancy in our hospital. Three cases had infective endocarditis (IE), who underwent heart valve placement with mechanical mitral valve, and one case with ascending aortic aneurysm underwent Bentall surgery. The operations of four cases were successful, and further follow-up evaluation of the pregnant women and fetus showed no abnormality. Patients' details are available in the following table. Conclusion: Actively and proactively for heart disease during pregnancy with obvious symptoms. Cardiac valve replacement under CPB will be the first choice, and this may become the primary surgical treatment for symptomatic heart diseases during pregnancy.

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Monitoring of r-Hirudin Anticoagulation during Cardiopulmonary Bypass – Assessment of the Whole Blood Ecarin Clotting Time

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656078 ◽

1997 ◽

Vol 77 (05) ◽

pp. 0920-0925 ◽

Cited By ~ 139

Author(s):

Bernd Pötzsch ◽

Katharina Madlener ◽

Christoph Seelig ◽

Christian F Riess ◽

Andreas Greinacher ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Whole Blood ◽

Heart Surgery ◽

Ex Vivo ◽

Open Heart Surgery ◽

Clotting Time ◽

Blood Samples ◽

Alternative Approach ◽

Ecarin Clotting Time

SummaryThe use of recombinant ® hirudin as an anticoagulant in performing extracorporeal circulation systems including cardiopulmonary bypass (CPB) devices requires a specific and easy to handle monitoring system. The usefulness of the celite-induced activated clotting time (ACT) and the activated partial thromboplastin time (APTT) for r-hirudin monitoring has been tested on ex vivo blood samples obtained from eight patients treated with r-hirudin during open heart surgery. The very poor relationship between the prolongation of the ACT and APTT values and the concentration of r-hirudin as measured using a chromogenic factor Ila assay indicates that both assays are not suitable to monitor r-hirudin anticoagulation. As an alternative approach a whole blood clotting assay based on the prothrombin-activating snake venom ecarin has been tested. In vitro experiments using r-hirudin- spiked whole blood samples showed a linear relationship between the concentration of hirudin added and the prolongation of the clotting times up to a concentration of r-hirudin of 4.0 µg/ml. Interassay coefficients (CV) of variation between 2.1% and 5.4% demonstrate the accuracy of the ecarin clotting time (ECT) assay. Differences in the interindividual responsiveness to r-hirudin were analyzed on r-hirudin- spiked blood samples obtained from 50 healthy blood donors. CV- values between 1.8% and 6% measured at r-hirudin concentrations between 0.5 and 4 µg/ml indicate remarkably slight differences in r-hirudin responsiveness. ECT assay results of the ex vivo blood samples linearily correlate (r = 0.79) to the concentration of r-hirudin. Moreover, assay results were not influenced by treatment with aprotinin or heparin. These findings together with the short measuring time with less than 120 seconds warrant the whole blood ECT to be a suitable assay for monitoring of r-hirudin anticoagulation in cardiac surgery.

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