Lower limit of adequate oxygen delivery for the maintenance of aerobic metabolism during cardiopulmonary bypass in neonates.

Background: The objective of cardiopulmonary bypass (CPB) is to maintain an adequate balance between oxygen delivery (Ḋo) and consumption. The critical Ḋo is that at which consumption becomes supply dependent. This study aimed to identify the critical Ḋo in neonates, who have higher metabolic rates than adults.

Impact of Heparin- or Nonheparin-Coated Circuits on Platelet Function in Pediatric Cardiac Surgery.

Background: Extracorporeal circuit coating has been shown to improve coagulation derangements during pediatric cardiopulmonary bypass (CPB). This study compared platelet function and hemostasis activation in pediatric cardiac surgery conducted with nonheparin coating (Balance; Medtronic, Minneapolis, MN) versus heparin-based coating (Carmeda; Medtronic) circuits.

Methods: A prospective, randomized, double-center trial was conducted in children older than 1 month undergoing congenital heart disease treatment.

Low perfusion pressure is associated with renal tubular injury in infants undergoing cardiac surgery with cardiopulmonary bypass: A secondary analysis of an observational study.

Background: Earlier work on adults undergoing surgery with cardiopulmonary bypass suggests that there is a close relationship between the lower limit of the cerebral and renal autoregulation pressures. Although cerebral autoregulation during bypass in infants has been extensively investigated, the impact of bypass on kidney function is not well known. It is, nevertheless, acknowledged that the main pathophysiological process involved in cardiac surgery-related kidney damage is tubular injury, and that urine neutrophil gelatinase-associated lipocaline (uNGAL) is a reliable biomarker of injury.

Cold histidine-tryptophan-ketoglutarate solution and repeated oxygenated warm blood cardioplegia in neonates with arterial switch operation.

Background: The present study aimed to compare myocardial protection, as assessed by cardiac troponin-I release, and short-term outcomes between two groups of neonates undergoing the arterial switch operation (ASO) with either Custodiol cardioplegia (Custodiol HTK, Köhler Chemie GmbH, Bensheim, Germany) or repeated oxygenated warm blood cardioplegia.

Methods: A total of 218 neonates were enrolled retrospectively from February 2007 through February 2011. All analyses were stratified on the type of procedure (ASO±ventricular septal defect closure ± aortic arch repair).

Use of a miniaturized cardiopulmonary bypass circuit in neonates and infants is associated with fewer blood product transfusions.

Miniaturized bypass circuits, including the Kids D100 oxygenator and the D130 arterial filter, were specially designed to reduce blood transfusions in small infants undergoing cardiac surgery. This study compared the number of blood product transfusions and short-term outcome between patients younger than 1 year undergoing cardiac surgery with a conventional and a miniaturized bypass circuit, after controlling for baseline characteristics and surgical complexity by 1:1 matching. Adjusted odds ratios (ORs) and 95% confidence intervals for exposure to transfusions and to any additional transfusion were estimated from binary and polytomous regression models.