Kadner Alexander, Heinisch Paul Philipp, Bartkevics Maris, Wyss Serena, Jenni Hans-Joerg, Erdoes Gabor, Eberle Balthasar, Carrel Thierry
Center for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, University Hospital, University Bern, Bern, Switzerland.
Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital, University Bern, Bern, Switzerland.
J Thorac Dis. 2019 Jun;11(Suppl 10):S1446-S1452. doi: 10.21037/jtd.2019.01.95.
Minimal invasive extracorporeal circulation (MiECC) circuits are an established alternative to conventional extracorporeal circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac surgery, this perfusion concept appears particularly attractive to pediatric cardiac surgery. So far, there are no reports on the clinical application of a MiECC system for corrective surgery in neonates and children. We report our initial experiences by using a MiECC system in pediatric cardiac surgery.
A total of 38 pediatric patients underwent surgical interventions for a variety of congenital heart disease from March 2017 until August 2018 with a MiECC. Following the classification of MiECC circuits by the Minimal invasive Extra-Corporeal Technologies International Society (MiECTIS), type I and type III perfusion circuits were assembled depending on the planned intervention: type I for closed heart interventions and type III for open heart procedures. Primary outcome was conversion to CECC, secondary endpoints included major adverse cardiac or cerebrovascular events (MACCE).
MiECC perfusion was successfully performed in all patients (100%). Median patient age was 9.5 months (range, 0.2-176 months) with a median weight of 8.1 kg (range, 2.3-49 kg). For both MiECC types no system related technical complications were encountered. Beating heart procedures were performed in 23 cases (60%) at normothermia, while in 15 (40%) interventions cardioplegic cardiac arrest was induced at mild hypothermia. All patients had an uneventful perioperative course with no in-hospital mortality. MACCE did not occur during the hospitalization period.
MiECC can be performed by using standard techniques for closed and open cardiac procedures for the correction of a variety of malformations in neonates and children with good results and uneventful postoperative course.
微创体外循环（MiECC）回路是传统体外循环（CECC）的既定替代方案。基于MiECC在成人心脏手术中的积极效果和改善的围手术期结果，这种灌注概念对小儿心脏手术显得特别有吸引力。到目前为止，尚无关于MiECC系统在新生儿和儿童矫正手术中临床应用的报道。我们报告了在小儿心脏手术中使用MiECC系统的初步经验。
2017年3月至2018年8月，共有38例小儿患者使用MiECC对各种先天性心脏病进行了手术干预。根据国际微创体外技术协会（MiECTIS）对MiECC回路的分类，根据计划的干预措施组装I型和III型灌注回路：I型用于闭式心脏干预，III型用于开胸心脏手术。主要结局是转为CECC，次要终点包括主要不良心脏或脑血管事件（MACCE）。
所有患者（100%）均成功进行了MiECC灌注。患者中位年龄为9.5个月（范围0.2 - 176个月），中位体重为8.1 kg（范围2.3 - 49 kg）。两种MiECC类型均未遇到与系统相关的技术并发症。23例（60%）在常温下进行了心脏跳动手术，而15例（40%）干预在轻度低温下诱导了心脏停搏。所有患者围手术期过程顺利，无住院死亡。住院期间未发生MACCE。
MiECC可通过使用标准技术进行闭式和开胸心脏手术，用于矫正新生儿和儿童的各种畸形，效果良好，术后过程顺利。
