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ATS December 2008: Pediatric Warm Open Heart Surgery and Prolonged...
Posted:
Dec 30, 2008 2:03 PM
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[nobr]ATS December 2008: Durandy, Yves D., et al. Pediatric Warm Open Heart Surgery and Prolonged Cross-Clamp Time. Ann Thorac Surg 2008;86:1941-1947.
In the December 2008 Annals Yves Durandy et al report on their strategy for normothermic CPB in children, partially exerpted herein. Although in wide use, the safety of normothermic pediatric cardiac surgery remains controversial. The study was an assessment of CPB associated with intermittent warm blood cardioplegia during prolonged aortic XLT. The retrospective study included 234 consecutive patients weighing less than 10 kg operated under CPB from August 2006 to November 2007. Group 1 contained 38 patients with XLT exceeding 90 minutes, and group 2 had 196 patients with shorter XLT. Outcomes were compared with those from the STS-EACTS database. Results, expressed as values for group 1 vs those for group 2, were mortality, 5.3% vs 2%; hospital stay > 21 days, 5% vs 0.5%; delayed chest closure, 21% vs 2.6%; epinephrine infusion, 45% vs 11%; organ failure, 13% vs 2%; reoperation for bleeding, 3% vs 0.5%; heart block, 3% vs 1%; time to extubation, in hours, 64 vs 19; lactate concentrations after CPB, 2.6 vs 1.9 mmol/L; length of stay in ICU, in hours, 100 vs 52. The authors could conclude that despite expected differences between the two groups, results were within the range of values described in the literature. The conclusion is that warm pediatric cardiac surgery with a long XLT is safe. The authors note that a large, multicenter, randomized prospective study comparing normothermic and hypothermic pediatric cardiac surgery is underway.
The authors have clearly shown that their strategy is safe even for long XCL times, although a claim for the superiority of this technique awaits results of a larger study. In the interim the debate continues with proponents of both extremes of CPB temperature achieving similar results. The points for argument therefore become more and more subtle.
Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/86/6/1941 and add your own comments and experience in the Dilemmas in Pediatric Cardiac Surgery Discussion Forum. [/nobr]
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