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Original Articles: Pediatric Cardiac

Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time

^a Department of Perfusion and Intensive Care, Institut Hospitalier Jacques Cartier, Massy, France
^b Department of Pediatric Cardiac Surgery, Institut Hospitalier Jacques Cartier, Massy, France
^c Department of Pediatric Pneumology, Institut Hospitalier Jacques Cartier, Massy, France

Accepted for publication August 4, 2008.

^_* Address correspondence to Dr Durandy, Perfusion and Intensive Care Unit, Institut Hospitalier Jacques Cartier, Avenue du Noyer Lambert, Massy, 91300, France (Email: iciprea{at}icip.org).

Background: The safety of normothermic pediatric cardiac surgery remains controversial. This study evaluated the performance of normothermic cardiopulmonary bypass (CPB) associated with intermittent warm blood cardioplegia during prolonged aortic cross-clamp time (CCT).

Methods: This retrospective study included 234 consecutive patients weighing less than 10 kg operated under CPB from August 2006 to November 2007. Patients were divided into two groups: group 1 contained 38 patients with CCT exceeding 90 minutes, and group 2 had 196 patients with shorter CCT. Classic factors were used to analyze outcomes, and outcomes were compared with those from the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery database.

Results: Results, expressed as values for group 1 vs those for group 2, were mortality rate, 5.3% vs 2%; length of hospital stay exceeding 21 days, 5% vs 0.5%; delayed chest closure, 21% vs 2.6%; epinephrine infusion, 45% vs 11%; organ failure, 13% vs 2%; reoperation due to bleeding, 3% vs 0.5%; heart block, 3% vs 1%; time to extubation, in hours, 64 ± 94 vs 19 ± 48; plasma lactate concentrations after bypass, 2.6 vs 1.9 mmol/L; length of stay in intensive care, in hours, 100 ± 105 vs 52 ± 48.

Conclusions: Despite expected differences between the two groups, our results were within the range of values described in the literature. This led us to conclude that warm pediatric cardiac surgery with a long CCT is safe. A large, multicenter, randomized prospective study comparing normothermic and hypothermic pediatric cardiac surgery is underway.

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François Lacour-Gayet
Ann. Thorac. Surg. 2008 86: 1947. [Extract] [Full Text] [PDF]

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				F. Lacour-Gayet Invited Commentary Ann. Thorac. Surg., December 1, 2008; 86(6): 1947 - 1947. [Full Text] [PDF]