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

Boettcher, Wolfgang; Dehmel, Frank; Redlin, Matthias; Sinzobahamvya, Nicodème; Photiadis, Joachim

doi:10.1055/s-0039-1700529

Cited by 15 publications

(9 citation statements)

References 58 publications

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“…However, we have noticed in clinical practice that postoperative AKI remained common in neonates even after anemia was corrected. Therefore, with the promotion of blood-saving strategy in infant CHD surgery ( 27 ) and the recognition of intraoperative blood transfusion-related risks ( 7 ), identifying the high-risk population of anemia-related AKI according to novel indicators is of vital importance to improve the prognosis of neonates as well as optimize the rational use of blood products.…”

Section: Discussionmentioning

confidence: 99%

Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates

et al. 2022

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BackgroundThe association of high-sensitivity C-reactive protein (hsCRP) and anemia with postoperative acute kidney injury (AKI) in neonates with congenital heart disease (CHD) is still unclear. The purpose of this study was to examine whether anemia-associated AKI is modulated by hsCRP in neonates.MethodsThis study included 253 consecutive neonatal patients who underwent CHD surgery in a national tertiary hospital. We investigated the association between postoperative AKI with baseline hsCRP, anemia, and their interaction by multivariable logistic regression analyses.ResultsThe incidence of AKI was 24.1% in the entire cohort. After being adjusted for covariates, hsCRP level was negatively correlated with AKI (P < 0.01 for 1 mg/L threshold), whereas anemia emerged as an independent risk factor of AKI (P = 0.02). In addition, there was a significant interaction between anemia and hsCRP level (P = 0.01). In neonates with hsCRP < 1 mg/L, anemia was positively associated with AKI (P = 0.03). However, no significant association was found between anemia and AKI in the context of hsCRP ≥ 1 mg/L. Combination of anemia and hsCRP < 1 mg/L was independently correlated with the risk of AKI (P < 0.01), while concomitant anemia and hsCRP ≥ 1 mg/L or hsCRP < 1 mg/L combined with non-anemia was not.ConclusionsIn neonates with CHD, the risk of anemia-associated AKI may be modulated by hsCRP level. Attention should be paid to neonates with preoperative anemia and baseline hsCRP < 1 mg/L to reduce the risk of postoperative AKI.

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Section: Discussionmentioning

confidence: 99%

Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates

et al. 2022

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“…Hemodilution can be reduced by pumping cardioplegic solution from the coronary sinus, spontaneous diuresis, or ultrafiltration. [ 22 ] In our center, we routinely open the right atrium during HTK perfusion. Extra cardioplegia is collected by blood salvage through the coronary sinus to avoid hemodilution.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative blood consumption did not indicate any different hemodilution effects between the two groups. Hemodilution can be reduced by pumping cardioplegic solution from the coronary sinus, spontaneous diuresis, or ultrafiltration [22] . In our center, we routinely open the right atrium during HTK perfusion.…”

Section: Discussionmentioning

confidence: 99%

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Bai

Tong

Liu

et al. 2021

Chinese Medical Journal

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Background: Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion. Methods: A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group ( n = 63, 40 mL/kg < HTK ≤ 60 mL/kg) and a high-dose (HD) group ( n = 83, HTK >60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias. Results: The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P < 0.0001), a lower proportion of complete transposition of the great artery (69.8% vs. 85.5%, P = 0.022), a lower cardiopulmonary bypass (CPB) time (123.5 [108.0, 136.0] vs. 132.5 [114.8, 152.5] min, P = 0.034), and a lower aortic x-clamp time (82.9 ± 27.1 vs. 95.5 ± 26.0 min, P = 0.005). After PSM, 44 patients were assigned to each group; baseline characteristics and CPB parameters between the two groups were comparable. There were no significant differences in peri-CPB blood product consumption after PSM ( P > 0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay ( P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups. Conclusions: In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.

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“…The amount of priming volume depended on patients’ body weight and ranged from 75 to 95 mL as previously reported. 7,10 It contained a balanced electrolyte solution and 2,500 to 5,000 IU heparin. A minimal hematocrit of 24% and hemoglobin (Hb) levels of at least 8 g/dL during CPB were targeted.…”

Section: Methodsmentioning

confidence: 99%

Acute Kidney Injury After Neonatal Aortic Arch Surgery: Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermia With Distal Aortic Perfusion

Böttcher

Weixler

Redlin

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Acute kidney injury (AKI) is a common complication observed after neonatal aortic arch repair. We studied its incidence after procedures carried out using deep hypothermic circulatory arrest (DHCA) versus moderate hypothermia with distal aortic perfusion (MHDP), usually through the common femoral artery. In both groups, continuous regional cerebral perfusion (RCP) was used during the time required for aortic arch repair. Methods: A total of 125 neonates underwent aortic arch repair. Between 2007 and 2012, DHCA with RCP was used in 51 neonates. From 2013 to 2019, MHDP with RCP was performed on 74 newborns. Operative complexity was similar in both periods. Acute kidney injury was defined as a significant elevation of serum creatinine and was classified according to the neonatal modified n-KDIGO (neonatal Kidney Disease: Improving Global Outcomes) stages 1 to 3 (Kidney Disease Improving: Global Outcomes). Results: Acute kidney injury was observed in a total of 68 patients (68/125: 54.4%). In the majority (44/68: 64.7%), n-KDIGO stage 1 occurred. Stage 2 (n = 14) and stage 3 (n = 10) were observed more frequently after DHCA versus MHDP: 29.4% (15/51) versus 12.2% (9/74), P = .02. At cardiopulmonary bypass end, lactate levels were significantly higher ( P = .001) after DHCA: 3.4 (2.9-4.3) mmol/L compared to 2.7 (2.3-3.7) mmol/L after MHDP. Early mortality was 12% (15/125) in the entire cohort. It was 17.6% (9/51) after DHCA versus 8.1% (6/74) after MHDP, however not statistically significant ( P = .16). Conclusion: Mild (stage 1) AKI occurred frequently after neonatal aortic arch repair. The use of MHDP was associated with a significantly lower incidence of moderate (stage 2) and severe (stage 3) AKI forms.

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

Cited by 15 publications

References 58 publications

Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates

Association of high-sensitivity C-reactive protein and anemia with acute kidney injury in neonates

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Acute Kidney Injury After Neonatal Aortic Arch Surgery: Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermia With Distal Aortic Perfusion

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