Perfusion Department, CCML, Le Plessis Robinson, France; Intensive Care Department, CCML, Le Plessis Robinson, France.
Front Pediatr. 2016 May 6;4:43. doi: 10.3389/fped.2016.00043. eCollection 2016.
Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia-reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.
心脏手术得益于上世纪 50 年代低温和心肺旁路的引入而发展起来。深低温保护作用对于复杂的停循环病例修复至关重要。在心脏直视手术的早期，主要关注点是降低死亡率和改善短期预后。在几十年内，死亡率和发病率都显著降低。因此，深低温的缺点，无论是否伴有停循环，变得越来越明显。低温的局限性对于大脑尤为明显，区域灌注应运而生以应对这一问题。尽管区域灌注的应用越来越广泛，但结果并不完全令人信服。上世纪 90 年代，成人温热手术被引入并被证明是安全可靠的。这种方法通过持续的、全身的含氧温热血液冠状动脉灌注来消除缺血再灌注损伤的有害影响。随后引入了间歇性温热血停搏液，取得了令人印象深刻的效果。我们被温热手术的简便、安全性和高效性所折服，并分两步将其应用于小儿温热手术。本文概述了低温保护的局限性以及导致我们实施小儿温热手术的基本原因。在几个中心进行了数万例手术之后，这种可复制的技术已被证明是低温手术的一种有价值的替代方法。
