Normothermic CPB in congenital heart disease—an experience of 653 cases

Abstract

Background Lichenstein first established normothormic cardio pulmonary bypass as safe and effective method. We have been using normothromic CPB in all case including infants and neonates. The safety and efficacy in 653 congenital heart disease cases were retrospectively analyzed. Materials and methods From March 2001 to September 2009, 653 cases of congenital heart disease operated under normothermic systemic and myocardial perfusion. The age range being from 27 days to 66 years with mean age of 16± 12.5 yrs. Weight ranges from 3.5 kg to 75 kg. Ninety-five (14.5%) cases were being operated below 10 kg. The body surface area was 0.16–2.01 with mean of 1.04±0.41. The procedures performed includes Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) repair. Intra cardiac repair for Tetralogy of Fallot (TOF), Double Chamber Right Ventricle (DCRV), Total Anomalous Pulmonary Venous Connection (TAPVC), Atrio Ventricular (AV) canal defect, Ruptured Sinus of Valsalva (RSOV) repair, Mitral repair etc. Results The total Cardiopulmonary Bypass (CPB) time was 19–322 min with mean of 56±33.07 min. Arrhythmia during weaning was seen in 27 cases. 231 cases required inotropic support. No patient had complete heart block. None of the patient developed edema of heart and all cases chest was closed primarily. The average post operative ventilator duration was 8±2.3 h, total average bleeding was 130±24 ml. Re-exploration was done in 3 cases. Post operative neurological complication occurred in one case, Hyperpyrexia in 6 cases and mortality was in 32 (4.9%) cases. Conclusion Normothermic systemic and myocardial perfusion in congenital heart disease is safe and physiological. This can be safely performed even in infants with reduced morbidity and mortality.