Pouard Philippe, Mauriat Philippe, Ek François, Haydar Ayman, Gioanni Simone, Laquay Nathalie, Vaccaroni Leticia, Vouhé Pascal R
Department of Anesthesiology, Hôpital Necker Enfants Malades, 149 rue de Sèvres, Paris, France.
Eur J Cardiothorac Surg. 2006 Nov;30(5):695-9. doi: 10.1016/j.ejcts.2006.07.032. Epub 2006 Sep 28.
Hypothermic cardiopulmonary bypass (CPB) associated with cold myocardial protection is commonly used to perform neonatal cardiac surgery. Hypothermia is usually chosen to preserve the brain in case of failure of oxygen delivery whatever it may result from. Nowadays, there is a growing number of evidence demonstrating that hypothermia induces deleterious effects, which may culminate in organ dysfunctions. In 2001, we started a protocol where the heart and the body were no longer cooled, in all the procedures, including the arterial switch operation (ASO), except those with aortic arch reconstruction.
Because data on the neonatal arterial switch operation were prospectively gathered in our unit (and included fine biochemical analysis of myocardial damage), we have compared two consecutive populations of arterial switch operation to sort out the impact of normothermic CPB and normothermic cardioplegia.
The results show that warm cardiopulmonary bypass associated with warm cardioplegia is feasible for ASO, and that most of the operative data are similar to hypothermic bypass, none are worse. Among the postoperative data, the cardiac troponin I (cTnI) time course showed significantly lower values in the normothermic group after 24 h (4.46 ng ml(-1) vs 6.17 ng ml(-1) (p = 0.027)), time to extubation is improved (32+/-26 h vs 70+/-69 h (p = 0.02)) and there is a trend to reduce the ICU length of stay (3.5+/-1.5 days vs 5.6+/-3.9 days (p = 0.08)), and consequently the cost of surgery.
Normothermic cardiopulmonary bypass is feasible for ASO and seems to allow a faster recovery time.
