Pediatric Cardiopulmonary Bypass

Deep hypothermic circulatory arrest and global reperfusion injury: Avoidance by making a pump prime reperfusate—A new concept

“…Clinical reports show that deep DHCA can increase morbidity and mortality by adversely changing postoperative organ function through ischemia and reperfusion damage, a presumably unavoidable consequence of DHCA. [13][14][15]19,20 Our study confirmed that DHCA, followed by normal blood reperfusion (uncontrolled), produces vascular, tissue, and neurologic damage, with cardiac and pulmonary dysfunction. In contrast, controlled reperfusion with a modified reperfusate limits the formation of oxygen-derived free radicals, resulting in preservation of vascular, cardiac, pulmonary, and neurologic function.…”

“…Such an injury would explain why generalized edema and multiple organ impairment are common after deep hypothermic circulatory arrest (DHCA). [13][14][15] Studies in individual organs (heart, lung, kidney, and skeletal muscle), however, have shown that the fate of ischemic tissue is determined more by the method of reperfusion than by the duration of ischemia itself. 1,2,[5][6][7][8][9][10][11][12] It may therefore be possible to limit this global reperfusion injury after DHCA by applying the principles of controlled reperfusion pioneered in individual organs.…”

Two unusual complications associated with cardiopulmonary bypass for pediatric cardiac surgery detected by transesophageal echocardiography after decannulation

“…Although aortoatriocaval cannulation is now the most widely used method, arterial and venous cannulation in pediatric patients, especially neonates, can be difficult (3). Various complications associated with aortoatrial cannulation have long been reported.…”