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Ann Thorac Surg 1994;57:293-297
© 1994 The Society of Thoracic Surgeons

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Articles

Fetal cardiac bypass: Improved placental function with moderately high flow rates

^a Divisions of Cardiothoracic Surgery and Cardiology, The University of Utah School of Medicine Salt Lake City, Utah, USA
^b Primary Children's Medical Center, Salt Lake City, Utah, USA
^c Division of Pediatric Cardiothoracic Surgery, University of Cincinnati School of Medicine Cincinnati, Ohio, USA
^d Children's Hospital Medical Center, Cincinnati, Ohio, USA

^_* Address reprint requests to Dr Hawkins, Department of Surgery, The University of Ulah Medical Center, 50 North Medical Dr, Salt Lake City, UT 84112.

Prenatal correction of certain cardiac lesions with a poor prognosis may have advantages over postnatal repair. For this to be done, safe and effective support of the fetal circulation must be devised. Studies involving fetal cardiac bypass have demonstrated progressive fetal hypoxemia, hypercapnia, and acidosis, indicating placental dysfunction. We performed fetal cardiac bypass in 18 fetal lambs (126 to 140 days' gestation) to assess the effect of flow rate on fetal oxygenation and metabolism and function of the placenta as an in vivo oxygenator. Fetal cardiac bypass was done for a 30-minute study period at normothermia in all fetuses. During the study period the fetal aorta was cross-clamped and cold cardioplegia was administered to the heart so there was no fetal cardiac contribution to systemic output. Nine fetuses underwent studies at low flow rates (109 ± 20 mL · kg^–1 · min^–1) and 9 at higher flow rates (324 ± 93 mL · kg^–1 · min^–1). At the lower flow rate, mean aortic pressure, arterial pH, and oxygen tension decreased whereas carbon dioxide tension and lactate levels increased when compared with prebypass levels. At the higher flow rate mean aortic pressure, pH, oxygen tension, carbon dioxide tension, and lactate levels remained similar to prebypass levels during the 30-minute study period. When the animals were weaned from the bypass circuit after studies at high flow rates, arterial oxygen tension and pH decreased whereas carbon dioxide tension increased to levels similar to those in the low-flow group. We conclude that low fetal cardiac bypass flow rates (100 to 125 mL · kg^–1 · min^–1) are inadequate to maintain hemodynamics, oxygenation, CO₂ removal, and normal lactate levels when the placenta is used as an in vivo oxygenator. Higher flow rates 1300 to 400 mL · kg^–1 · min^–1) may limit these changes by improving placental perfusion and function during bypass. Despite high flow rates, placental dysfunction and fetal blood gas abnormalities still occur after fetal cardiac bypass.

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