Comparison between D901 Lilliput 1 and Kids D100 neonatal oxygenators: toward bypass circuit miniaturization.

Progress in biomaterial technology and improvements in surgical and perfusionstrategy ameliorated morbidity and mortality in pediatric cardiac surgery. Inthis study, we describe our clinical experience comparing performance of twoneonatal oxygenators. From January 2002 to March 2011, 159 infants with less than5 kg body weight underwent heart surgery. Ninety-four patients received a D901Lilliput 1 oxygenator with standard bypass circuit (group A), while 65 received aD100 Kids with miniaturized bypass circuit (group B). Miniaturization consistedin shortened arterial, venous, cardioplegia, and pump-master lines. Primingcomposition consisted in Ringer's acetate solution with addition of albumin andblood, with target hematocrit of 24% or greater. In group B cardiopulmonarybypass (CPB) was vacuum-assisted and started with an empty venous line. Modified ultrafiltration and Cell-Saver blood infusion was routinely applied in bothgroups. Average ± standard deviation (SD) age at repair was 37 ± 38 days in groupA and 59 ± 60 days in group B (P = 0.005). Average ± SD weight, height, and body surface area were 3.5 ± 0.7 kg, 52 ± 4 cm, and 0.22 ± 0.03 m(2) , respectively,in group A, and 3.7 ± 1 kg, 53 ± 5 cm, and 0.23 ± 0.02 m(2) , respectively, ingroup B (P = not significant [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 hemoglobin at the start,during, and at the end of CPB, but group A required higher blood volume added to the prime (111 ± 33 vs. 93 ± 31 mL, P = 0.001). In group B, two surgicalprocedures were completed in total hemodilution. In group B, CPB time and aortic cross-clamp time were shorter than in group A (106 ± 52 vs. 142 ± 78 min and44 ± 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 andintensive care unit stay were 5.3 ± 3.2 vs. 4.1 ± 3.2 days (P = 0.02) and6.5 ± 4.9 vs. 5.1 ± 3 days (P = 0.03), respectively. There were significantdifferences in inotropic score (1083 ± 1175 vs. 682 ± 938, P = 0.04) and bloodpostoperative transfusion (153 ± 226 vs. 90 ± 61 mL, P = 0.04). Twenty-sevenpatients in group A and 10 in group B presented with major adverse postoperative complications (P = 0.04). Use of neonatal oxygenators with low priming volume,associated with a miniaturized bypass circuit, seems to be a favorable strategyto decrease postoperative morbidity after cardiac surgery in neonates andinfants.