Randomized comparison between mild and moderate hypothermic cardiopulmonary bypass for neonatal arterial switch operation
European Journal of Cardio-thoracic Surgery, cilt.41, sa.3, ss.581-586, 2012 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 41 Sayı: 3
- Basım Tarihi: 2012
- Doi Numarası: 10.1093/ejcts/ezr002
- Dergi Adı: European Journal of Cardio-thoracic Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.581-586
- Anahtar Kelimeler: Arterial switch operation, Normothermic cardiopulmonary bypass, Mild hypothermic cardiopulmonary bypass, Warm paediatric cardiac surgery
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: To compare neonates receiving arterial switch operation (ASO) either with mild or moderate hypothermic cardiopulmonary bypass. Methods: Forty neonates undergoing ASO were randomized to receive either mild (Mi>32°C, n=20) or moderate (Mo>26°C, n=20) hypothermic cardiopulmonary bypass (CPB) between April 2007 and June 2010. All patients were diagnosed with simple transposition of the great arteries. Mean age (Mi: 8.32 ±4.5 days, Mo: 7.54 ±5.0 days, P=0.21) and body weight were similar in both groups (Mi: 3.64 ± 0.91 kg, Mo: 3.73 ± 0.84 kg, P=0.14). Follow-up was 3.1 ± 2.5 years for all patients. Results: Lowest perioperative rectal temperature was 33.5± 1.4°C (Mi) versus 28.2±2.1°C (Mo) (P<0.001). All patients safely weaned from CPB required lower doses of dopamine (Mi: 5.1 ±2.4 μg/kg min, Mo: 6.5 ±2.1 μ/kg min, P=0.04), dobutamine (Mi: 7.2 ± 2.5 μg/kg min, Mo: 8.6±2.4μ/kg min, P=0.04) and adrenalin (Mi: 0.02 ± 0.02 μg/kg min, Mo: 0.05 ±0.03 μ/kg min, P=0.03) in mild hypothermia group. Intraoperative blood transfusion (Mi: 190 ±58 ml, Mo: 230 ±24 ml, P=0.03) and postoperative lactate levels (Mi: 2.7 ±0.9 mmol/l, Mo: 3.1 ±2.2 mmol/l, P=0.02) were lower under mild hypothermia. Secondary chest closure was performed in 30% (Mi) versus 35% (Mo) (P=0.65). Duration of inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15) days, P=0.03), time to extubation (Mi: 108 (88-128) h, Mo: 128 (102-210) h, P=0.04), lengths of intensive care unit (ICU) stay (Mi: 9 (5-14) days, Mo: 12 (10-18) days, P=0.04) and hospital stay (Mi: 19 (10-29) days, Mo: 23 (15-37) days, P=0.04) were significantly shorter under mild hypothermia. Two-year freedom from reoperation was 100% for both the groups. Conclusions: The ASO under mild hypothermia seemed to be beneficial for pulmonary recovery, need for inotropic support and length of ICU and hospital stay. No worse early-or intermediate-term effects of mild hypothermia were found. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.