Rationale for Implementation of Warm Cardiac Surgery in Pediatrics.

Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes.

Is there a rationale for short cardioplegia re-dosing intervals?

While cardioplegia has been used on millions of patients during the last decades, the debate over the best technique is still going on. Cardioplegia is not only meant to provide a non-contracting heart and a field without blood, thus avoiding the risk of gas emboli, but also used for myocardial protection. Its electromechanical effect is easily confirmed through direct vision of the heart and continuous electrocardiogram monitoring, but there is no consensus on the best way to assess the quality of myocardial protection.

Use of blood products in pediatric cardiac surgery.

In pediatric cardiac surgery, there is a substantial gap between published recommendations or guidelines for blood product use and clinical practice. The drawbacks of blood transfusion are well acknowledged though. The aim of this paper is to present the rationale for packed red blood cells, fresh frozen plasma (FFP), and platelets used in pediatric patients.

Minimizing systemic inflammation during cardiopulmonary bypass in the pediatric population.

Cardiopulmonary bypass (CPB) is known to cause a systemic inflammatory response. Inflammation includes several cascade activations: complement, cytokine, and coagulation. The early phase is triggered by blood contact with the synthetic bypass circuit and the late phase by ischemia-reperfusion and endotoxemia.

An original versatile nonocclusive pressure-regulated blood roller pump for extracorporeal perfusion.

Currently, only a small number of centrifugal pumps are being used for hemodynamic and/or respiratory support, but all of them have limitations. This article aims to present the Rhône-Poulenc 06 nonocclusive pressure-regulated blood pump. This pump was developed in France in the 1970s and used for decades in perfusion for cardiopulmonary bypass procedures, cardiac or lung assist as well as venovenous bypass during liver transplant.

Vacuum-assisted venous drainage, angel or demon: PRO?

Vacuum-assisted venous drainage (VAVD) was proposed to optimize venous drainage during bypass through femoral venous cannulation. It is currently used in both adult and pediatric surgery when siphon gravity venous drainage is suboptimal. In pediatric surgery, the major advantages of VAVD are a significant decrease in cardiopulmonary bypass prime volume and an improved drainage with all collateral benefits.

Characteristics of a nonocclusive pressure-regulated blood roller pump.

For decades, extracorporeal life support (ECLS) systems have relied on pumps designed for short-term cardiopulmonary bypass. In the past, occlusive roller pumps were the standard. They are being progressively replaced by centrifugal pumps and devices developed specifically for ECLS.

A nonocclusive, inexpensive pediatric pulsatile roller pump for cardiopulmonary bypass, extracorporeal life support, and left/right ventricular assist systems.

A simple, inexpensive pediatric pulsatile roller blood pump has been utilized for routine cardiopulmonary bypass (CPB) procedures, extracorporeal life support (ECLS), and left/right ventricular assist systems (LVAS/RVAS) for decades in France. This particular nonocclusive pulsatile system has many advantages including several safety features for patients as well as an extremely lower cost. The objective of this study is to evaluate the performance of this particular system for CPB, ECLS, and LVAS/RVAS in pulsatile mode.

Pre- and postoperative magnetic resonance imaging in neonatal arterial switch operation using warm perfusion.

Neurological morbidity is a major concern in pediatric cardiac surgery. Cardiopulmonary bypass is one of the few modifiable factors affecting neurodevelopmental outcome. This study aimed to measure the incidence of abnormalities apparent by magnetic resonance imaging (MRI) after neonatal arterial switch operation using warm surgery.

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment.

In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater.

Perfusionist strategies for blood conservation in pediatric cardiac surgery.

There is increasing concern about the safety of homologous blood transfusion during cardiac surgery, and a restrictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuum-assisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retrograde autologous priming.

Blood transfusion in pediatric cardiac surgery.

The aim of the study is to measure the volume of homologous blood needed for one pediatric patient during his hospital stay. Over a 4-month period, all the patients operated upon with a blood prime or requiring blood transfusion during their hospital stay were included in this study.The cardiopulmonary bypass protocol associates a miniaturized bypass circuit, vacuum-assisted venous drainage, and microplegia.

Warm pediatric cardiac surgery: European experience.

Cold pediatric cardiac surgery has been a dogma for 50 years. However, the beneficial effects of cold perfusion are counterbalanced by the drawbacks of hypothermia. Thus, we propose a major paradigm shift from hypothermic surgery to warm perfusion and intermittent warm blood cardioplegia.

The impact of vacuum-assisted venous drainage and miniaturized bypass circuits on blood transfusion in pediatric cardiac surgery.

Although blood transfusion is essential in pediatric surgery, it is associated with increased morbidity. The goal of this study is to assess the efficiency of downsized bypass circuits and vacuum-assisted venous return in decreasing the need for blood transfusion. This study was performed on 150 patients weighing 2.

Pediatric warm open heart surgery and prolonged cross-clamp time.

Background: The safety of normothermic pediatric cardiac surgery remains controversial. This study evaluated the performance of normothermic cardiopulmonary bypass (CPB) associated with intermittent warm blood cardioplegia during prolonged aortic cross-clamp time (CCT).

Methods: This retrospective study included 234 consecutive patients weighing less than 10 kg operated under CPB from August 2006 to November 2007.

Pediatric myocardial protection.

Purpose Of Review: Myocardial protection has contributed greatly to significant advances in pediatric cardiac surgery. New refinements in perfusion techniques and cardioplegia are under evaluation. Genetic factors are also promising tools to assess and improve myocardial protection.

Usefulness of low prime perfusion pediatric circuit in decreasing blood transfusion.

We tested the efficiency of small prime volume in decreasing the blood requirement during pediatric cardiac surgery. This is a retrospective analysis of transfusion in 259 consecutive patients weighing <15 kg. We downsized the bypass circuit and avoided noncritical components to obtain a cardiopulmonary bypass prime volume, including a cardioplegia circuit of 140 ml for patients up to 6 kg, and of 170 ml for those weighing 6-15 kg.

Postoperative mediastinitis in children: improvement of simple primary closed drainage.

Background: Mediastinitis is a significant cause of postoperative morbidity. In 1989, we proposed simple primary closed drainage as a new treatment. Our goal is to describe improvements made to the original technique.