A Comparison of the Effects on Postoperative Course of Hypothermic Circulatory Arrest Versus Continuous Cardiopulmonary Bypass in Infants Arterial Switch Operation / 대한마취과학회지

BACKGROUND: Hypothermic circulatory arrest is a widely used support technique during heart surgery in neonate and infants, but the difference in the effects of perfusion methods, total arrest versus continuous flow, on postoperative course has been controversial. METHODS: This study was retrospectively designed to examine the difference in effects of deep hypothermic circulatory arrest or continuous flow perfusion on postoperative courses including mortality and neurologic morbidity after arterial switch operation through chart review. We also examined the relationship between intraoperative data and postoperative outcomes. RESULTS: Of 72 patients, 44 patients (Total Circulatory Arrest (TCA) group; 26 patients had intact ventricular septum, 18 patients had ventricular septal defect) were treated with total arrest, and 28 patients (Continuous Perfusion Flow (CPF) group; 13 patients had intact ventricular septum, and 15 patients had ventricular septal defect) were treated with continuous flow. Hospital course, postoperative hemodynamic profiles, incidence of complications excluding neurology and mortality were not different between two groups. The incidence of neurologic abnormalities was higher two times in TCA group than in CPF group but was not significantly different. CONCLUSIONS: We could not confirm the differences in postoperative outcomes between both techniques, total circulatory arrest and continuous flow perfusion during arterial switch operation in neonates and infants.

The Effects of Perfusion Variables on the Neurologic Sequelae in the Infants Who had Arterial Switch Operation Using Continuous Flow Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Neurologic sequelae of open heart surgery for congenital heart disease were related with preexisting brain lesion as well as intraoperative causes. These causes are microemboli, blood flow, and blood distribution. METHODS: This study was designed to examine neurologic sequelae and postoperative course in patients with arterial switch operation using continuous flow cardiopulmonary bypass through retrospective chart review. RESULTS: Of 22 patients 4 had neurologic sequelae. Cooling rate, extubation time, and duration of ICU admission and hospital admission were statistically different between the patients with neurologic sequelae or not. Patients with neurologic sequelae had more rapid cooling rate and longer duration of intubation, ICU stay, and hospital admission than patients without neurologic sequelae. CONCLUSIONS: Cooling rate (time to lower 1oC body temperature) is the only factor among perfusion variables to affect on neurologic sequelae. Neurologic complications make it longer to wean the mechanical ventilation, and to stay at ICU and hospital.