Trends and Updates on Cardiopulmonary Bypass Setup in Pediatric Cardiac Surgery

Medikonda, Ravi; Ong, Chin Siang; Wadia, Rajeev; Goswami, Dheeraj; Schwartz, Jamie McElrath; Wolff, Lawrence B.; Hibino, Narutoshi; Nyhan, Daniel; Barodka, Viachaslau; Steppan, Jochen

doi:10.1053/j.jvca.2019.01.025

Cited by 11 publications

(7 citation statements)

References 98 publications

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“…Based on the modified International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics, 11 postoperative cardiovascular disorder was defined as (i) decrease in blood pressure (hypotension) greater than 5th percentile for age or systolic blood pressure less than 2 SD below normal for age; (ii) need for higher doses of vasoactive drug to maintain blood pressure in normal range (vasoactive‐inotropic score [VIS] of greater than 415 points: 12 VIS = dopamine dose (μg/kg/min) + dobutamine dose (μg/kg/min) + 100 × epinephrine dose (μg/kg/min) + 10 × milrinone dose (μg/kg/min) + 10,000 × vasopressin dose (units/kg/min) + 100 × norepinephrine dose (μg/kg/min); or (iii) two of the following: unexplained metabolic acidosis: base deficit > 5.0 mEq/L, increased arterial lactate greater than two times upper limit of normal, oliguria: urine output less than 0.5 ml/kg/h, prolonged capillary refill greater than 5 s, core to peripheral temperature gap greater than 3°C, despite administration of isotonic intravenous fluid bolus greater than 40 ml/kg in 1 h, as well as postoperative use of renal replacement therapy, extracorporeal membrane oxygenation, intra‐aortic balloon pump, or ventricular assist device. Cardiovascular disorders were determined throughout postoperative 7 days, hospital discharge, or death, whichever occurred first.…”

Section: Methodsmentioning

confidence: 99%

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Liu

Zhang

et al. 2021

Journal of Cardiac Surgery

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Background: Little is known regarding whether hyperoxic reoxygenation was associated with higher risk of cardiovascular disorder following tetralogy of Fallot repair. Methods:We performed a nested case-control study among patients aged 1 month-18 years undergoing complete repair of tetralogy of Fallot in 2012-2018.We measured the highest perfusate oxygenation (PpO2) during aortic occlusion in 107 cardiovascular disorder cases and in 321 controls matched 1:3 to the cases on date of surgery, sex, and area of residence. We analyzed the association between PpO2 and outcome using multivariable conditional logistic regression adjusted for covariates. We further identified and integrated the risk covariates to build prediction nomograms. Results: Cases had higher percentage of exposure to PpO2 > 200 mmHg (86.0% vs. 76.1%, p = .019) than controls. Patients with PpO2 > 200 mmHg had an increased risk of cardiovascular disorder compared to those with PpO2 ≤ 200 mmHg (odd ratio [OR] = 2.075, 95% confidence interval [CI] = 1.035, 4.158, p = .039) adjusted for matching, clinical and procedural covariates. Categorical PpO2, lower body mass index, lower SpO2, untreated minor aortopulmonary collateral arteries, high immediately postoperative central venous pressure, and longer cardiopulmonary bypass time were independent risk factors for cardiovascular disorder (all p < .05). Combining PpO2 nomogram slightly improved discrimination compared with covariate-based nomogram alone for training cohort (area under receiver operating characteristic curve [AUC] = 0.768 vs. 0.761) and for internal validation (AUC = 0.759 vs. 0.753). Conclusion:Our findings suggest association exists between high PpO2 during aortic occlusion and cardiovascular disorder risk, and nomogram integrating clinical and procedural factors may be useful in management of patients with tetralogy of Fallot.

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Section: Methodsmentioning

confidence: 99%

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Liu

Zhang

et al. 2021

Journal of Cardiac Surgery

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“…The early fetal heart pattern is formed by the eighth week in utero, and further development of the heart is in uenced by the pattern of fetal blood ow [5][6] . Theoretically, if congenital heart disease can be operated on during the fetal period, the transformation of an abnormality into a complex one can be prevented, complex postnatal cardiac surgery can be avoided, the heart can be given a chance to develop further in utero, and secondary morphologic damage can be avoided [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Cardioprotective Methods on Extracorporeal Circulation in Fetal Sheep: A Randomized Controlled Trial

Yan

Shi

et al. 2020

Preprint

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Background Congenital heart disease is one of the leading causes of death in newborns and infants. The development of fetal cardiac surgery is inextricably linked to extracorporeal circulation. We aimed to compare the effects of heart-stopping solutions and extracorporeal circulation on fetal sheep myocardium.Methods Eighteen pregnant sheep were divided into the non-stop group, St. Thomas stopping solution group, and histidine–tryptophan–ketoglutarate stopping solution group. The three groups underwent the extracorporeal circulation. The right atrial myocardial tissue was removed from the fetal sheep at specific time points, and apoptosis was detected by TUNEL staining. Creatine kinase‒muscle band (CKMB), troponin I (cTnI), and troponin T (cTnT) were measured as indicators of myocardial damage.Results There were no significant differences in the serum cTnT, cTnI, and CKMB concentrations of fetal sheep among the three groups before starting extracorporeal circulation (P = 0.430, P = 0.391, P = 0.071). Changes in the serum cTnI (ng/L) concentrations were not significantly different among the three groups before and during the extracorporeal circulation (P > 0.05). The cTnI in the St. Thomas solution group at 1 hour post extracorporeal circulation was significantly higher than prior to it (P < 0.05), and cTnI in the non-stop group and histidine–tryptophan–ketoglutarate group after 2 hours was higher than in the pre-bypass value (P < 0.05). The cTnI in the histidine–tryptophan–ketoglutarate group at 1 and 2 hours after the extracorporeal circulation was lower than in the St. Thomas solution group. The number of TUNEL-positive cells in the two solution groups was higher than in the non-stop group (P = 0.001 and P = 0.048, respectively). The number of TUNEL-positive cells in the St. Thomas solution group was higher than in the histidine–tryptophan–ketoglutarate group (P = 0.007).Conclusion Myocardial protection in fetal sheep undergoing extracorporeal circulation was significantly better with non-stop beating than when the beating was stopped. Compared to the St. Thomas arrest solution, histidine‒tryptophan‒ketoglutarate stopping solution was associated with significantly reduced markers of myocardial damage in fetal sheep. Less cardiomyocyte apoptosis was observed when the beating was not stopped.

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“…Cardiopulmonary bypass (CPB) reoxygenation is a major perioperative management issue that plays a crucial role in complete repair of Tetralogy of Fallot. 1,2 Increasing evidence has suggested that hyperoxic CPB is associated with an increased risk of mortality and morbidity due to possible hypoxia/reoxygenation injuries to critical organs. 3 Although great efforts have been made to investigate the consequences of hyperoxic CPB, no data exist regarding whether difference in the haematocrit modifies the association of CPB reoxygenation with acute kidney injury (AKI) following Tetralogy of Fallot repair.…”

Section: Introductionmentioning

confidence: 99%

Haematocrit differences modify the association of cardiopulmonary bypass reoxygenation with acute kidney injury after paediatric Tetralogy of Fallot repair

Zheng

Qian

et al. 2019

Perfusion

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Background: Little is known regarding the potential impact of haematocrit differences in the association between cardiopulmonary bypass reoxygenation and acute kidney injury following Tetralogy of Fallot repair. Methods: We investigated the association of perfusate oxygenation during aortic occlusion associated with acute kidney injury between 204 normal and 248 higher haematocrit children with Tetralogy of Fallot, aged 1 month-18 years, who were surgically repaired in 2012-2018. Normal and higher haematocrit children were defined as having a preoperative haematocrit within and above age- and sex-specific reference intervals, respectively. Acute kidney injury was determined as a binary variable according to the Kidney Disease Improving Global Outcomes criteria. Results: After adjusting for baseline and clinical covariates, a significant interaction between the haematocrit and continuous perfusate oxygenation on acute kidney injury was found (pinteraction = 0.049): a higher perfusate oxygenation was associated with a greater acute kidney injury risk among higher haematocrit children (adjusted odds ratio = 1.50, 95% confidence interval = [1.02, 2.22] per SD, p = 0.038) but not among normal haematocrit children (adjusted odds ratio = 0.91, 95% confidence interval = [0.51, 1.63] per SD, p = 0.73). After a similar adjustment, there was a marginal interaction between tertiles of perfusate oxygenation and haematocrit on acute kidney injury (pinteraction = 0.09): the middle and top tertiles of perfusate oxygenation were associated with a trend towards increased acute kidney injury risks among higher haematocrit children (adjusted odds ratio = 1.69, 95% confidence interval = [0.61, 4.66]; adjusted odds ratio = 2.25, 95% confidence interval = [0.84, 5.99], respectively) but not among normal haematocrit children (adjusted odds ratio = 1.16, 95% confidence interval = [0.46, 2.94]; adjusted odds ratio = 0.45, 95% confidence interval = [0.15, 1.36], respectively) compared with the bottom tertile. Conclusion: Preoperative haematocrit differences significantly modify the association of perfusate oxygenation with acute kidney injury, highlighting differential control of reoxygenation for different haematocrit children with Tetralogy of Fallot in the management of cardiopulmonary bypass.

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Trends and Updates on Cardiopulmonary Bypass Setup in Pediatric Cardiac Surgery

Cited by 11 publications

References 98 publications

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Effect of Different Cardioprotective Methods on Extracorporeal Circulation in Fetal Sheep: A Randomized Controlled Trial

Haematocrit differences modify the association of cardiopulmonary bypass reoxygenation with acute kidney injury after paediatric Tetralogy of Fallot repair

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