The Benefits of High‐flow Management in Children With Pulmonary Atresia

Abstract

The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.

Clinical experience with Affinity Pixie™ oxygenation system in paediatric and infant patients

“…Cardiopulmonary bypass is required for the vast majority of surgically corrective procedures undertaken within an open heart and on the great vessels. Recent work by Fujii et al 7 has shown that paediatric patients require far higher cardiac indexes than traditionally given to adult patients, especially those with cyanotic heart disease. This is reflected in our retrospective data (Figure 1).…”

Artificial Organs 2009: A Year in Review

“…Yasuhiro Fujii et al. (70) of Okayama University Hospital, Okayama City, Okayama, Japan described the validity of high‐flow management in children with pulmonary atresia (PA). The CPB records of 23 children with PA who underwent a definitive biventricular repair were retrospectively reviewed.…”

Sixth International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion

“…Our special thanks go to Angela T. Hadsell, Executive Editor, and Paul S. Malchesky, DEng, Editor‐in‐Chief, for making this possible. We have already published several manuscripts covering all areas of pediatric cardiopulmonary bypass and mechanical circulatory support systems in terms of clinical (1–10), basic science (11–13), and engineering (14–23) applications in the November 2009 Special Issue of Artificial Organs .…”