Management of cardiopulmonary bypass with beating heart during the first stage palliative operation for cyanotic infants with right ventricle to pulmonary artery shunts

Abstract

Objective To summarize the clinical experiences of cardiopulmonary bypass(CPB) with beating heart during the first stage palliative operation for right ventricle to pulmonary artery shunts in cyanotic infants. Methods A retrospective analysis on 17 cases of cyanotic infants underwent right ventricle to pulmonary artery shunts from Sep.2009 to Jun.2011 was performed.Ten cases were male and 7 cases were female.The median age was 9.7 months(2.5-73.8) months, and the median weight was(8.3±3.4) kg.All infants were finished under mild hypothermia CPB and reasonable hemodilution with fresh frozen plasma, maintained with beating heart under lower preload.Conventional ultrafiltration, zero-balance and modified ultrafiltration were all applied in the whole CPB procedure. Results The average fresh frozen plasma volume was(285.6±27.9) mL.The average temperature was(34.2±1.8) ℃.The perfusion flow ranged from 55 to 100 mL/kg.The average mean artery pressure was(5.7±0.6) kPa, and the urine volume was(12.1±5.7) mL/kg.In this group, the average CPB time was(76.2±36.4) min, and the ave-rage intubation time was(55.7±45.3) h and the duration of in-hospital was(12.7±6.5) days.All infants survived. Conclusions Reasonable implementation of CPB management strategy, can guarantee the successful completion of cyanotic children in the beating heart with palliative right ventricle-pulmonary artery connection operation, and effectively reduce the incidence of postoperative complications. Key words: Cyanotic; Cardiopulmonary bypass; Beating heart; Infant