Recent Advances in Pediatric Cardiopulmonary Bypass

Abstract

There have been numerous recent advances geared specifically toward the practice of pediatric cardiopulmonary bypass (CPB). These advances include the development of the first oxygenator intended solely for the neonatal CPB patient; pediatric oxygenators with low prime volumes and surface areas, which allow flows up to 2 L/min; pediatric oxygenators with integrated arterial filters; and miniature ultrafiltration (UF) devices, which allow for high rates of ultrafiltrate removal. When used in combination with heart lung machines with mast-mounted pumps, these advances can result in significant decreases in CPB circuit surface areas and prime volumes. This may attenuate CPB-associated hemodilution and decrease or eliminate the need for homologous red blood cells during or after CPB. In addition to these equipment-related advances, changes in myocardial protection strategies and the technique of modified UF as it relates to these advances are discussed.

Pattern of Congenital Heart Disease among Libyan Children: A Single Centre Study

“…It should be noted that the advances in pediatric cardiovascular surgery and cardiac interventional catheterization have shown improved outcomes in patients with underlying heart defects [22][23]. Nevertheless, CHD remains a major cause of rbidity and mortality in pediatric population, and places a heavy financial burden on the community, particularly in developing countries [24].…”

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

“…For most programs, the largest circuit component contributing to the dilution of the patient is the overall length and internal diameter of the tubing used in the CPB circuit. However, a limited number of institutions have reduced tubing length and size to the point, that the components of the circuit (oxygenator, filter, hemoconcentrator, and heat exchanger) have become the largest contributor to the overall circuit volume (34,35). While there is no current standard for tubing size in extracorporeal circuits, it is a common practice to use the smallest internal diameter tubing that does not create excessive line pressure resulting in hemolysis, arterial cannula cavitation gaseous microemboli or aortic dissection caused by the high-pressure jet from an arterial cannula during the conduct of bypass (36).…”

“…The range these oxygenators operate within results in patient mismatch at the lower end of the operating range. Currently, commercially-available oxygenators have prime volumes approaching 10 mL (35).…”

“…Thus, it is more advantageous to decrease the distance (tubing length) between the pump and the patient. This can be accomplished by mounting pumps on masts of the CPB machine that can then be positioned more closely to the patient (35). However, there are also practical limitations to the proximity of the pump to the patient as it increases the chance of sterile field compromise and limits space for the scrubbed surgical team.…”

Evolution, Practice, and Challenges of Cardiopulmonary Bypass

“…Dr McRobb and his group discuss "Recent Advances in Pediatric Cardiopulmonary Bypass," 6 including development of the pediatric oxygenator with low prime volumes and surface areas, integrated arterial filters, and miniature ultrafiltration devices. These advances can result in a significant decrease in cardiopulmonary bypass circuit surface areas and prime volumes, with attenuation of cardiopulmonary bypass-associated hemodilution, and a decrease in the need for homologous red blood cell transfusion.…”