Acute Kidney Injury With a Miniaturized Extracorporeal Circuit for Neonatal Cardiopulmonary Bypass.

Objectives: The objectives of this study were to evaluate the incidence and to identify risk factors for acute kidney injury (AKI) in neonates undergoing cardiopulmonary bypass (CPB) with a miniaturized bloodless primed extracorporeal circuit.

Design: A retrospective cohort study.

Setting: A single-center, tertiary academic hospital.

Coagulation Profile of Neonates Undergoing Arterial Switch Surgery With Crystalloid Priming of the Cardiopulmonary Bypass Circuit.

Objectives: The aim was to evaluate changes in the coagulation profile of cyanotic neonates, to analyze the effects of cardiopulmonary bypass (CPB) with crystalloid priming on their coagulation status, and to determine factors predicting a requirement for hemostasis-derived transfusion.

Design: Retrospective cohort.

Setting: Single-center, tertiary academic hospital.

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

Priming 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.

Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity.

Background: We routinely start cardiopulmonary bypass (CPB) for pediatric congenital heart surgery without homologous blood, due to circuit miniaturization, and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity, in infants weighing ≤ 7 kg?

Methods: Six-hundred fifteen open-heart procedures performed from January 2014 to June 2018 were selected.

Bloodless priming of the cardiopulmonary bypass circuit: determinants of successful transfusion-free operation in neonates and infants with a maximum body weight of 7 kg.

We currently perform open-heart procedures using bloodless priming of cardiopulmonary bypass circuits regardless of a patient's body weight. This study presents results of this blood-saving approach in neonates and infants with a body weight of up to 7 kg. It tests with multivariate analysis factors that affect perioperative transfusion.

Asanguineous priming of miniaturized paediatric cardiopulmonary bypass circuits for congenital heart surgery: independent predictors associated with transfusion requirements and effects on postoperative morbidity.

Objectives: In paediatric cardiac surgery, body weight-adjusted miniaturized cardiopulmonary bypass (CPB) circuits within a comprehensive blood-sparing approach can reduce transfusion requirements. Haemodilution resulting from mixing the patient's blood with a CPB crystalloid solution may be reduced to the extent that asanguineous priming becomes possible. Therefore, we adopted asanguineous priming in our clinical routine.

Additional veno-venous gas exchange as a problem-solving strategy for an oxygenator not transferring oxygen in paediatric cardiopulmonary bypass.

Objectives: Oxygenator failure during cardiopulmonary bypass constitutes a life-threatening event, especially when perfusion is conducted under normothermia. An alternative solution to emergency oxygenator changeover is described.

Methods: A supplementary oxygenator is added in the venous line without interrupting perfusion.

Complex Cardiac Surgery on Patients with a Body Weight of Less Than 5 kg without Donor Blood Transfusion.

Performing safe cardiac surgery in neonates or infants whose parents are Jehovah's Witnesses is only possible in a coordinated team approach. An unconditional prerequisite is a cardiopulmonary bypass (CPB) circuit with a very low priming volume to minimize hemodilution. In the past decade, we have developed a functional blood-sparing approach at our institution.

Accuracy of predicted haemoglobin concentration on cardiopulmonary bypass in paediatric cardiac surgery: effect of different formulae for estimating patient blood volume.

Introduction: When applying a blood-conserving approach in paediatric cardiac surgery with the aim of reducing the transfusion of homologous blood products, the decision to use blood or blood-free priming of the cardiopulmonary bypass (CPB) circuit is often based on the predicted haemoglobin concentration (Hb) as derived from the pre-CPB Hb, the prime volume and the estimated blood volume. We assessed the accuracy of this approach and whether it may be improved by using more sophisticated methods of estimating the blood volume.

Patients And Methods: Data from 522 paediatric cardiac surgery patients treated with CPB with blood-free priming in a 2-year period from May 2013 to May 2015 were collected.

Routine Application of Bloodless Priming in Neonatal Cardiopulmonary Bypass: A 3-Year Experience.

A restrictive transfusion strategy led us to routinely try to conduct donor-blood free open-heart surgery even in neonates. The cardio-pulmonary bypass (CPB) circuit was minimized by priming volumina at 73 ml for the smallest patients with body weight up to 2.5 kg and 85-95 ml for those with body weight of more than 2.

Red blood cell storage duration is associated with various clinical outcomes in pediatric cardiac surgery.

Background: Recommendations on the use of fresh red blood cells (RBCs) in pediatric patients undergoing cardiac surgery are based on limited information. Furthermore, the RBC storage time cut-off of fresh units remains unknown.

Methods: Data from 139 pediatric patients who underwent cardiac surgery and received RBCs from a single unit within 14 days of storage were analyzed.

Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach.

Objective: Recently we suggested a comprehensive blood-sparing approach in pediatric cardiac surgery that resulted in no transfusion in 71 infants (25%), postoperative transfusion only in 68 (24%), and intraoperative transfusion in 149 (52%). We analyzed the effects of transfusion on postoperative morbidity and mortality in the same cohort of patients.

Methods: The effect of transfusion on the length of mechanical ventilation and intensive care unit stay was assessed using Kaplan-Meier curves.

Effects of a comprehensive blood-sparing approach using body weight-adjusted miniaturized cardiopulmonary bypass circuits on transfusion requirements in pediatric cardiac surgery.

Objectives: Transfusion-free pediatric cardiac surgery remains a challenge, mainly owing to the mismatch between the cardiopulmonary bypass (CPB) priming volume and the infants' blood volume. Within a comprehensive blood-sparing approach, we developed body weight-adjusted miniaturized CPB circuits with priming volumes of 95, 110, and 200 mL for, respectively, infants weighing less than 3 kg, 3 to 5 kg and 5 to 16 kg. We analyzed the effects of this approach on transfusion requirements and risk factors predisposing for blood transfusion.

Transfusion-free complex cardiac surgery: with use of deep hypothermic circulatory arrest in a preterm 2.96-kg Jehovah's witness neonate.

In neonates, the major obstacle to transfusion-free complex cardiac surgery is the severe hemodilution that can result from the mismatch between the priming volume of the circuit and the patients' blood volume. Herein, we report the case of a 13-day-old, 2.96-kg preterm neonate who had a hypoplastic aortic arch and atrial and ventricular septal defects.

Minimizing intraoperative hemodilution by use of a very low priming volume cardiopulmonary bypass in neonates with transposition of the great arteries.

Objective: Owing to the mismatch between cardiopulomary bypass priming volume and infants' blood volume, pediatric cardiac surgery is often associated with transfusion of homologous blood, which may increase the risk of perioperative complications. Here we report the impact of a very low volume (95-110 mL) cardiopulmonary bypass circuit during arterial switch operations in neonates with transposition of the great arteries on blood requirements, tissue oxygenation, and patient outcome.

Methods: Twenty-three consecutively treated neonates aged 2 to 17 days were treated with the blood-sparing approach.

How near-infrared spectroscopy differentiates between lower body ischemia due to arterial occlusion versus venous outflow obstruction.

Small infants undergoing cardiac surgery are at high risk for regional malperfusion during cardiopulmonary bypass. We report a 13-day-old neonate who underwent reconstruction of the aortic arch and closure of atrial and ventricular septum defects. Near-infrared spectroscopy probes were placed on the forehead and the calf to monitor tissue oxygenation and hemoglobin concentrations.

Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest.

We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.

Cerebral expression of neuroglobin and cytoglobin after deep hypothermic circulatory arrest in neonatal piglets.

Introduction: Deep hypothermic circulatory arrest (DHCA) is used in corrective cardiac surgery for complex congenital heart disease. Endogenous protective mechanisms may be responsible for the prevention of brain damage after hypothermic ischemia. Neuroglobin and cytoglobin are expressed in brain cells and appear to modulate hypoxic-ischemic brain injury.

Regional differences in tissue oxygenation during cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants: relevance of near-infrared spectroscopy.

Objective: Cardiac surgery with cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants is associated with considerable neurologic sequelae. We assessed the extent to which mixed venous oxygen saturation as a measure for adequacy of perfusion, reflects the oxygenation status of upper and lower body compartments. Moreover, we evaluated potential benefits of near-infrared spectroscopic monitoring of regional tissue oxygenation.

Transfusion-free arterial switch operation in a 1.7-kg premature neonate using a new miniature cardiopulmonary bypass system.

In cardiac surgery, the potentially detrimental effects of transfusions on patient outcome are increasingly appreciated. Therefore, at our institution there are continuing efforts to modify our surgical, perfusion, and blood management strategies with the aim of transfusion-free cardiac surgery even in neonates and small children. Stringent improvement of these strategies, particularly the downsizing of the cardiopulmonary bypass system, have now enabled a transfusion-free arterial switch operation in a 1700-gram prematurely born neonate.

Hybrid approach facilitates use of a minimized CPB circuit and transfusion free surgery in an extended Norwood stage II procedure.

Intraoperative stent implantation into a stenotic left pulmonary artery branch and surgical creation of a bidirectional Glenn anastomosis resulted in avoidance of aortic cross-clamping and transection of the aorta for surgical patching of the pulmonary artery. The hybrid approach thereby reduced the complexity of the surgical procedure, facilitated the use of a minimized cardiopulmonary bypass circuit, reduced the degree of hemodilution and blood trauma and resulted in transfusion-free surgery and excellent clinical outcome in an 11 kg child.

Transfusion-free cardiac reoperation in an 11-kg Jehovah's Witness child by use of a minimized cardiopulmonary bypass circuit.

Herein, we describe the design of a perfusion system for a complex cardiovascular reoperation in an 11-kg Jehovah's Witness patient. The goal of safe, transfusion-free surgery was achieved chiefly by minimizing the priming volume of the cardiopulmonary bypass circuit to 200 mL while providing adequate flow and standard safety features.