Division of Cardiac Surgery, University of Verona, Verona, Italy.
Artif Organs. 2013 Jan;37(1):E24-8. doi: 10.1111/aor.12017.
Progress in biomaterial technology and improvements in surgical and perfusion strategy ameliorated morbidity and mortality in pediatric cardiac surgery. In this study, we describe our clinical experience comparing performance of two neonatal oxygenators. From January 2002 to March 2011, 159 infants with less than 5 kg body weight underwent heart surgery. Ninety-four patients received a D901 Lilliput 1 oxygenator with standard bypass circuit (group A), while 65 received a D100 Kids with miniaturized bypass circuit (group B). Miniaturization consisted in shortened arterial, venous, cardioplegia, and pump-master lines. Priming composition consisted in Ringer's acetate solution with addition of albumin and blood, with target hematocrit of 24% or greater. In group B cardiopulmonary bypass (CPB) was vacuum-assisted and started with an empty venous line. Modified ultrafiltration and Cell-Saver blood infusion was routinely applied in both groups. Average ± standard deviation (SD) age at repair was 37 ± 38 days in group A and 59 ± 60 days in group B (P = 0.005). Average ± SD weight, height, and body surface area were 3.5 ± 0.7 kg, 52 ± 4 cm, and 0.22 ± 0.03 m(2) , respectively, in group A, and 3.7 ± 1 kg, 53 ± 5 cm, and 0.23 ± 0.02 m(2) , respectively, in group B (P = not significant [NS]). Male sex was predominant (55 vs. 58%, P = NS). Priming volume was 524 ± 67 mL (group A) and 337 ± 53 mL (group B) (P = 0.001). There were no statistical differences in hemoglobin at the start, during, and at the end of CPB, but group A required higher blood volume added to the prime (111 ± 33 vs. 93 ± 31 mL, P = 0.001). In group B, two surgical procedures were completed in total hemodilution. In group B, CPB time and aortic cross-clamp time were shorter than in group A (106 ± 52 vs. 142 ± 78 min and 44 ± 31 vs. 64 ± 31 min, respectively, P = 0.001). There were 16 hospital deaths in group A and 4 in group B (P = 0.04). Durations of mechanical ventilation and intensive care unit stay were 5.3 ± 3.2 vs. 4.1 ± 3.2 days (P = 0.02) and 6.5 ± 4.9 vs. 5.1 ± 3 days (P = 0.03), respectively. There were significant differences in inotropic score (1083 ± 1175 vs. 682 ± 938, P = 0.04) and blood postoperative transfusion (153 ± 226 vs. 90 ± 61 mL, P = 0.04). Twenty-seven patients in group A and 10 in group B presented with major adverse postoperative complications (P = 0.04). Use of neonatal oxygenators with low priming volume, associated with a miniaturized bypass circuit, seems to be a favorable strategy to decrease postoperative morbidity after cardiac surgery in neonates and infants.
在儿科心脏手术中，生物材料技术的进步和外科及灌注策略的改进改善了发病率和死亡率。在本研究中，我们描述了比较两种新生儿体外循环机性能的临床经验。从 2002 年 1 月至 2011 年 3 月，159 名体重小于 5 公斤的婴儿接受了心脏手术。94 名患者接受了带有标准旁路回路的 D901 Lilliput 1 体外循环机（A 组），而 65 名患者接受了带有小型旁路回路的 D100 Kids （B 组）。小型化包括缩短动脉、静脉、心脏停搏和泵主管道。预充液成分由含有白蛋白和血液的醋酸林格氏液组成，目标红细胞压积为 24%或更高。在 B 组中，心肺转流（CPB）是真空辅助的，静脉回路是空的开始。改良超滤和细胞保存血液输注在两组中常规应用。A 组修复时的平均年龄为 37±38 天，B 组为 59±60 天（P=0.005）。A 组的平均体重、身高和体表面积分别为 3.5±0.7 公斤、52±4 厘米和 0.22±0.03 平方米，B 组分别为 3.7±1 公斤、53±5 厘米和 0.23±0.02 平方米（P=无显著差异[NS]）。男性居多（55%比 58%，P=无显著差异[NS]）。预充液体积为 524±67 毫升（A 组）和 337±53 毫升（B 组）（P=0.001）。CPB 开始、期间和结束时的血红蛋白没有统计学差异，但 A 组需要向预充液中添加更多的血液（111±33 比 93±31 毫升，P=0.001）。在 B 组中，有两次手术是在完全血液稀释的情况下完成的。在 B 组中，CPB 时间和主动脉阻断时间短于 A 组（106±52 比 142±78 分钟和 44±31 比 64±31 分钟，P=0.001）。A 组有 16 例院内死亡，B 组有 4 例（P=0.04）。机械通气和重症监护病房的时间分别为 5.3±3.2 比 4.1±3.2 天（P=0.02）和 6.5±4.9 比 5.1±3 天（P=0.03）。有创性评分（1083±1175 比 682±938，P=0.04）和术后血液输注量（153±226 比 90±61 毫升，P=0.04）有显著差异。A 组 27 例和 B 组 10 例患者出现主要术后并发症（P=0.04）。使用新生儿体外循环机，预充液体积小，与小型旁路回路相结合，似乎是降低新生儿和婴儿心脏手术后发病率的有利策略。
