Thirty male patients undergoing coronary artery bypass grafting were divided into two groups, group I receiving pulsatile perfusion, group II nonpulsatile perfusion. A double roller pump system for extracorporeal circulation was employed. Intra- and postoperative fluid balances and bodyweight gains were controlled under clinical conditions. There were no significant differences between the groups with regard to clinical data, operative procedure, perfusion parameters, drug treatment or intensive care treatment. The intra-operative mean fluid balance of group I was 794.0ml (66%) lower than that of group II, while the balance 24 hours postoperatively was 136.7ml (37%) lower in group I. Thus, the total mean fluid balance for the pulsatile group was 931.0ml (59%) lower than the nonpulsatile group, in accordance with the bodyweights, which showed a 954.0g (63%) lower outcome in the pulsatile group. Less supplementary volume and higher urine production were the main factors. It appears that volume saved during pulsatile ECC need not be replaced postoperatively. These findings indicate that pulsatile perfusion leads to diminished fluid overloading, which could be an important advantage, especially for high-risk patients.
The main limitation in the use of circulatory support in children is the lack of an adequate system with regard to size and pumping capacity. Recently, two pneumatically driven ventricular support systems with low volume chambers for use in a pediatric population became available. We have developed a hydraulic drive system with an advantageous exact control of the stroke volume. The system enables two different modes of operation: the full-empty and the filled-empty modes. In both cases the ventricle is empty at the end of systole. This new system was tested in experimental animals (6 pigs, body weight 9.5-14.0 kg) with normal and reduced left ventricular function (MAP<45 mmHg). A 25 ml ventricle (HIA-Medos) was implanted. The full-empty and the filled-empty mode used led to a significant load reduction, both in animals with normal and impaired cardiac function. Plasma lactate levels, pH-values and total body O2-consumption were in the normal range during circulatory support indicating adequate organ perfusion. Results showed that sufficient ventricular support was achieved during all pumping modes due to the possibility of controlling and modifying the stroke volume of the hydraulically driven support system employed according to necessity. This is a promising feature for its future application in infants with congenital or acquired heart diseases.
Norwood operation and subsequent total cavopulmonary anastomosis in infants with systemic ventriculo-arterial hypoplasiaZusammenfassung Wegen eines hypoplastischen Linksherz Syndromes (HLHS) (n = 31) oder eines komplexen angeborenen Herzfehlers mit vergleichbarer H~imodynamik (n = 10) erhielten 41 S~uglinge von Oktober 1989 bis Oktober 1996 eine Norwood Operation. Als funktionelle HLHS lagen vor: Mitralatresie mit doppeltem Ausgang aus der rechten Kammer und schwerer subaortaler Stenose (n = 2), Atrioventrikul/irer Septumdefekt mit hypoplastischer linker Kammer und Aortenkoarktation (n = 1), hypoplastischer, subaortaler rechter Ventrikel mit restriktivem Ventrikelseptumdefekt und Aortenhypoplasie (n = 7). Das mediane Operationsalter betrug 15 Tage (5 bis 182 Tage), das mittlere Gewicht war 3,4 kg (3,0 bis 4,9 kg). Die operative Sterblichkeit betrug insgesamt mit 13 F/illen 32%. W/ihrend sie in den ersten 3 Jahren noch bei 50% (9 von 18 Patienten) lag, konnte sie seit 1994 auf 12% (2 von 17 Patienten) gesenkt werden. 5 Patienten (12%) verstarben spS.ter (2 Wochen bis 6 Monate), 2 Kinder wurden herztransplantiert. Von den 21 lang • erhielten 17 Patienten mit einem medianen Alter von 7 Monaten (2 bis 14 Monate) die obere, bidirektionale cavopulmonale Anastomose. 2 Kinder verstarben (12%) frª keines sp/it. Bisher erhielten 10 der 15 • nach einem mittleren Intervall von 12 Monaten die erg/inzende totale cavopulmonale Anastomose. Alle Kinder haben ª Sie waren mit durchschnittlich 20 Monaten fertig palliiert. Die l~ingste Beobachtungszeit nach totaler cavopulmonaler Anastomose betrfigt 6 Jahre und allen 10 Kindern geht es gut. Zusammenfassung: Die Ergebnisse der Norwood Operation werden mit wachsender Erfahrung besser. Die nachfolgende zweischrittige Fontan Operation hat dann nur noch ein relativ geringes Risiko und fª zu sehr guter Lebensqualitat. From October 1989 to October 1996 infants with hypoplastic left heart syndrome (HLHS) (n = 31) of complex cardiovascular malformations with comparable hemodynamics (n = 10) underwent the Norwood procedure. Complex cardiovascular malformations were: mitral atresia with double outlet right ventricle and severe subaortic stenosis (n = 2), atrioventricular septal defect with hypoplastic left ventricle and aortic coarctation (n = 1), hypoplastic subaortic right ventricle with restrictive ventricular septal defect and aortic hypoplasia (n = 7). The median age at operation was 64 Summary
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