Cardiopulmonary Bypass Management for Tetralogy of Fallot Infants Weighing Less Than 8 kg_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIPing ,  DONGNian-guo , DUXin-ling , ZHAOYang

Department of Cardiac Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China;

Corresponding author：

DONGNian-guo, Email: dongnianguo@hotmail.com

Keywords：

Cardiopulmonary bypass; Infant; Tetralogy of Fallot; Management

DOI：

10.7507/1007-4848.20140138

Video：

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Objective To summarize cardiopulmonary bypass (CPB) management experience in tetralogy of Fallot (TOF) infants weighing less than 8 kg. Methods A total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg.The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4:1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. Results CPB time was 65-200 (115.3±9.6) minutes, and aortic cross-clamping time was 40-110 (60.3 ±10.2) minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5±50.3 ml, and hematocrit (HCT) increased to 0.35-0.40 after modified ultrafiltra-tion. Heart beat was automatically recovered in 114 patients (95%) after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5±16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. Conclusion Appropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4:1 cold blood-potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of TOF in infants.

Citation： LIPing, DONGNian-guo, DUXin-ling, ZHAOYang. Cardiopulmonary Bypass Management for Tetralogy of Fallot Infants Weighing Less Than 8 kg. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 486-489. doi: 10.7507/1007-4848.20140138 Copy

1.	Ong J, Brizard CP, d'udekem Y, et al. Repair of atrioventricular septal defect associated with tetralogy of Fallot or double-outlet right ventricle:30 years of experience. Ann Thorac Surg, 2012, 94 (1):172-178.
2.	Kotani Y, Honjo O, Nakakura M, et al. Single center experience with a low volume priming cardiopulmonary bypass circuit for preven-ting blood transfusion in infants and small children. ASAIO J, 2009, 55 (3):296-299.
3.	Sanches C, Galas FR, Silva AG, et al. Propranolol plasma monitoring in children submitted to surgery of tetralogy of Fallot by a micromethod using high performance liquid chromatography. Clinics (Sao Paulo), 2007, 62 (3):215-224.
4.	Zhao J, Yang JG, Liu JP, et al. Effects of pulsatile and nonpulsatile perfusion on cerebral regional oxygen saturation and endothelin-1 in tetralogy of fallot infants. Artif Organs, 2011, 35 (3):E54-E58.
5.	Ghorbel MT, Mokhtari A, Sheikh M, et al. Controlled reoxygenation cardiopulmonary bypass is associated with reduced transcriptomic changes in cyanotic tetralogy of Fallot patients undergoing surgery. Physiol Genomics, 2012, 44 (22):1098-1106.
6.	Pepe S, Liaw NY, Hepponstall M, et al. Effect of remote ischemic preconditioning on phosphorylated protein signaling in children under-going tetralogy of Fallot repair:a randomized controlled trial.J Am Heart Assoc, 2013, 2 (3):e000095.
7.	Allan CK, Newburger JW, Mcgrath E, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg, 2010, 111 (5):1244-1251.
8.	Murayama H, Tamaki S, Usui A, et al. Measurement of cerebral-oxy-genation status when commencing cardiopulmonary bypass in pediatric open-heart surgery. Ann Thorac Cardiovasc Surg, 2006, 12 (2):105-112.
9.	Honjo O, Osaki S, Kotani Y, et al. Diagnosis-based differences in response of global ventricular performance to modified ultrafiltration in children. Circ J. J Cardiothorac Surg. 2010, 74 (1):86-92.
10.	Zhang R, Shen L, Xie Y, et al. Effect of morphine-induced postconditioning in corrections of tetralogy of fallot. J Cardiothorac Surg, 2013, 8:76.
11.	徐新根, 刁文瑜, 殷凤珍, 等.4比1含血心肌保护液的研究和临床应用.透析与人工器官, 2000, 11 (1):6-8.
12.	Suominen PK, Keski-Nisula J, Tynkkynen P, et al. The effect of tepid amino acid-enriched induction cardioplegia on the outcome of infants undergoing cardiac surgery. Perfusion, 2012, 27 (4):338-344.
13.	Chen Y, Liu JP, Li SJ, et al. Which is the better option during neonatal cardiopulmonary bypass:HTK solution or cold blood cardio-plegia? ASAIO J, 2012, 59 (1):69-74.
14.	Rong J, Ye S, Liang MY, et al. Receptor for advanced glycation end products involved in lung ischemia reperfusion injury in cardiopulmonary bypass attenuated by controlled oxygen reperfusion in a canine model. ASAIO J, 2013, 59 (3):302-308.
15.	Song LO, Li YL, Li JP. Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass. Perfusion, 2007, 22 (5):339-343.

1. Ong J, Brizard CP, d'udekem Y, et al. Repair of atrioventricular septal defect associated with tetralogy of Fallot or double-outlet right ventricle:30 years of experience. Ann Thorac Surg, 2012, 94 (1):172-178.
2. Kotani Y, Honjo O, Nakakura M, et al. Single center experience with a low volume priming cardiopulmonary bypass circuit for preven-ting blood transfusion in infants and small children. ASAIO J, 2009, 55 (3):296-299.
3. Sanches C, Galas FR, Silva AG, et al. Propranolol plasma monitoring in children submitted to surgery of tetralogy of Fallot by a micromethod using high performance liquid chromatography. Clinics (Sao Paulo), 2007, 62 (3):215-224.
4. Zhao J, Yang JG, Liu JP, et al. Effects of pulsatile and nonpulsatile perfusion on cerebral regional oxygen saturation and endothelin-1 in tetralogy of fallot infants. Artif Organs, 2011, 35 (3):E54-E58.
5. Ghorbel MT, Mokhtari A, Sheikh M, et al. Controlled reoxygenation cardiopulmonary bypass is associated with reduced transcriptomic changes in cyanotic tetralogy of Fallot patients undergoing surgery. Physiol Genomics, 2012, 44 (22):1098-1106.
6. Pepe S, Liaw NY, Hepponstall M, et al. Effect of remote ischemic preconditioning on phosphorylated protein signaling in children under-going tetralogy of Fallot repair:a randomized controlled trial.J Am Heart Assoc, 2013, 2 (3):e000095.
7. Allan CK, Newburger JW, Mcgrath E, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg, 2010, 111 (5):1244-1251.
8. Murayama H, Tamaki S, Usui A, et al. Measurement of cerebral-oxy-genation status when commencing cardiopulmonary bypass in pediatric open-heart surgery. Ann Thorac Cardiovasc Surg, 2006, 12 (2):105-112.
9. Honjo O, Osaki S, Kotani Y, et al. Diagnosis-based differences in response of global ventricular performance to modified ultrafiltration in children. Circ J. J Cardiothorac Surg. 2010, 74 (1):86-92.
10. Zhang R, Shen L, Xie Y, et al. Effect of morphine-induced postconditioning in corrections of tetralogy of fallot. J Cardiothorac Surg, 2013, 8:76.
11. 徐新根, 刁文瑜, 殷凤珍, 等.4比1含血心肌保护液的研究和临床应用.透析与人工器官, 2000, 11 (1):6-8.
12. Suominen PK, Keski-Nisula J, Tynkkynen P, et al. The effect of tepid amino acid-enriched induction cardioplegia on the outcome of infants undergoing cardiac surgery. Perfusion, 2012, 27 (4):338-344.
13. Chen Y, Liu JP, Li SJ, et al. Which is the better option during neonatal cardiopulmonary bypass:HTK solution or cold blood cardio-plegia? ASAIO J, 2012, 59 (1):69-74.
14. Rong J, Ye S, Liang MY, et al. Receptor for advanced glycation end products involved in lung ischemia reperfusion injury in cardiopulmonary bypass attenuated by controlled oxygen reperfusion in a canine model. ASAIO J, 2013, 59 (3):302-308.
15. Song LO, Li YL, Li JP. Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass. Perfusion, 2007, 22 (5):339-343.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cardiopulmonary Bypass Management for Tetralogy of Fallot Infants Weighing Less Than 8 kg

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