Progress in biomaterial technology and improvements in surgical and perfusion strategy ameliorated morbidity and mortality in pediatric cardiac surgery. In this study, we describe our clinical experience comparing performance of 2 neonatal oxygenators. From 01/2002 to 03/2011, 159 less than 5 kg body-weight babies underwent heart surgery. Ninety-four patients received a D901 Lilliput 1 oxygenator with standard bypass circuit (Group A), while 65 a D100 Kids with miniaturized bypass circuit (Group B). Miniaturization consisted in shortened arterial, venous, cardioplegia and pump-master lines. Priming composition consisted in ringer-acetate solution with addition of albumin and blood, with target Hct of 24% or greater. CPB was vacuum-assisted and started with empty venous line. MUF and Cell-Saver blood infusion was routinely applied. Average±SD age at repair was 37±38 in Group A and 59±60 days in Group B (p=0.005). Average±SD weight, height and BSA were 3.5±0.7 kg, 52±4 cm and 0.22±0.03 m2, respectively, in Group A, while 3.7±1 kg, 53±5 cm and 0.23±0.02 m2, respectively, in Group B (p=NS). Male sex was predominant (55% vs 58%, p=NS). Priming volume was 524±67 ml (Group A) and 337±53 ml (Group B) (p=0.001). There were no statistical differences in Hb at the start, during and at the end of CPB, but Group A required higher blood volume added to prime (111±33 vs 93±31 ml, p=0.001). In Group B, 2 surgical procedures were completed in total hemodilution. In Group B, CPB time and XCL time were shorter than in Group A (106±52 vs 142±78 min and 44±31 vs 64±31 min, respectively, p=0.001). There were 16 hospital deaths in Group A and 4 in Group B (p=0.04). Durations of mechanical ventilation and ICU stay were 5.3±3.2 vs 4.1±3.2 days (p=0.02) and 6.5±4.9 vs 5.1±3 days (p=0.03), respectively. There were significant differences in inotropic score (1083±1175 vs 682±938, p=0.04) and blood postoperative transfusion (153±226 vs 90±61 ml, p=0.04). Twenty-seven patients in Group A and 10 in Group B presented major adverse postoperative complications (p=0.04). Use of neonatal oxygenators with low priming volume, associated with miniaturized bypass circuit, seems to be a favourable strategy to decrease postoperative morbidity after cardiac surgery in neonates and infants.
Comparison between D901 Lilliput 1 and Kids D100 neonatal oxygenators: towards bypass circuit miniaturization.
DE RITA, Fabrizio;LUCCHESE, Gianluca;FAGGIAN, Giuseppe;MAZZUCCO, Alessandro;LUCIANI, GIOVANNI BATTISTA
2012-01-01
Abstract
Progress in biomaterial technology and improvements in surgical and perfusion strategy ameliorated morbidity and mortality in pediatric cardiac surgery. In this study, we describe our clinical experience comparing performance of 2 neonatal oxygenators. From 01/2002 to 03/2011, 159 less than 5 kg body-weight babies underwent heart surgery. Ninety-four patients received a D901 Lilliput 1 oxygenator with standard bypass circuit (Group A), while 65 a D100 Kids with miniaturized bypass circuit (Group B). Miniaturization consisted in shortened arterial, venous, cardioplegia and pump-master lines. Priming composition consisted in ringer-acetate solution with addition of albumin and blood, with target Hct of 24% or greater. CPB was vacuum-assisted and started with empty venous line. MUF and Cell-Saver blood infusion was routinely applied. Average±SD age at repair was 37±38 in Group A and 59±60 days in Group B (p=0.005). Average±SD weight, height and BSA were 3.5±0.7 kg, 52±4 cm and 0.22±0.03 m2, respectively, in Group A, while 3.7±1 kg, 53±5 cm and 0.23±0.02 m2, respectively, in Group B (p=NS). Male sex was predominant (55% vs 58%, p=NS). Priming volume was 524±67 ml (Group A) and 337±53 ml (Group B) (p=0.001). There were no statistical differences in Hb at the start, during and at the end of CPB, but Group A required higher blood volume added to prime (111±33 vs 93±31 ml, p=0.001). In Group B, 2 surgical procedures were completed in total hemodilution. In Group B, CPB time and XCL time were shorter than in Group A (106±52 vs 142±78 min and 44±31 vs 64±31 min, respectively, p=0.001). There were 16 hospital deaths in Group A and 4 in Group B (p=0.04). Durations of mechanical ventilation and ICU stay were 5.3±3.2 vs 4.1±3.2 days (p=0.02) and 6.5±4.9 vs 5.1±3 days (p=0.03), respectively. There were significant differences in inotropic score (1083±1175 vs 682±938, p=0.04) and blood postoperative transfusion (153±226 vs 90±61 ml, p=0.04). Twenty-seven patients in Group A and 10 in Group B presented major adverse postoperative complications (p=0.04). Use of neonatal oxygenators with low priming volume, associated with miniaturized bypass circuit, seems to be a favourable strategy to decrease postoperative morbidity after cardiac surgery in neonates and infants.
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