Absorbable sutures for cardiopulmonary bypass purse strings in pediatric heart surgery.

BACKGROUND: Absorbable sutures, commonly used in general surgery, are not routinely used as purse strings for arterial and venous cannulation for cardiopulmonary bypass in pediatric heart surgery. The general concern is absorbable sutures could predispose to immediate postoperative bleeding; this safety concern has been evaluated in this retrospective study. MATERIALS AND METHODS: A single center, retrospective study, was conducted with criteria for inclusion patient <18 years of age, operation on with cardiopulmonary bypass for heart surgery from July 1, 2018 to June 30, 2020, with purse strings for cannulation performed with absorbable sutures. Data collection included demographics at the time of surgery, site of arterial and venous cannulation with absorbable purse strings, bleeding, required reoperation, related hospital mortality, and complications. RESULTS: One hundred and ninety-eight patients, mean ± standard deviation (SD) age of 1597 ± 3021 days, mean ± SD body weight of 15.9 ± 18.8 kg, were operated on using absorbable sutures for purse strings for arterial and venous cannulation: No bleeding was reported, either intraoperative or in the immediate postoperative period, related to the type of sutures used for purse strings for cannulation. No hospital deaths or complications related to the type of sutures were observed. CONCLUSIONS: Based on the results of our analysis, we can conclude that the utilization of purse strings absorbable sutures for arterial and venous cannulation for cardio-pulmonary bypass in children is safe in relationship to the intraoperative and immediate postoperative period. No complications related to the use of absorbable sutures have been observed in a large pediatric patient population.

Results of Less Than 5-mm Right Ventricle-Pulmonary Artery Conduits in Single Ventricle Palliation.

BACKGROUND: Our programmatic approach to single ventricle (SV) neonatal palliation has evolved to using smaller-size right ventricle to pulmonary artery (RV-PA) conduits for pulmonary blood flow. Therefore, we sought to compare the early outcomes of less than 5-mm versus 5-mm RV-PA conduits in SV patients undergoing neonatal palliation. METHODS: We performed a retrospective review of SV patients who had neonatal palliation with either a less than 5-mm or 5-mm RV-PA connection, constructed using a waterproof, breathable fabric membrane graft (Gore-Tex, Flagstaff, AZ). Data before, during, and after surgery were analyzed using SPSS software. RESULTS: A total of 26 patients in group 1 (n = 11; <5 mm) and group 2 (n = 15; 5 mm) were operated on, with a mean follow-up of 13 months. Statistical differences (P ≤ .05) were noted with renal near-infrared spectroscopy (mean, 56 versus 44), and oxygen saturation at discharge (mean, 80% versus 85%) in groups 1 and 2, respectively. We found no significant difference in patient weight, peak lactate, cerebral near-infrared spectroscopy, length of intubation, length of hospitalization, or need for RV-PA conduit intervention after stage 1 along with age, branch PA sizes, or need for PA plasty at bidirectional Glenn between groups. CONCLUSIONS: Our early results of less than 5-mm conduits support further exploration into the tailoring of the RV-PA conduit size for each patient. A smaller-diameter conduit may improve systemic cardiac output and net oxygen delivery. Larger patient cohorts and longer follow-up with assessment of pulmonary artery growth are warranted to guide clinical practice.

A Retrospective Analysis of the Use of 3-Factor Prothrombin Complex Concentrates for Refractory Bleeding After Cardiopulmonary Bypass in Children Undergoing Heart Surgery: A Matched Case-Control Study.

The 3-factor prothrombin complex concentrate (3FPCC) may be used off-label to treat refractory bleeding during cardiac surgery in children. This retrospective study examined the rate of clinical complications following the use of 3FPCC. Patients treated with 3FPCC were matched to controls for age, gender, prematurity, weight, cardiopulmonary bypass times, and cross-clamp times. Fifty-nine cases were individually matched to 59 controls based on propensity scores. 3FPCC was not associated with an increased risk of thromboembolic events, mortality, or need for postoperative extracorporeal membrane oxygenator support. These results suggest the safety of 3FPCC when used for refractory bleeding after cardiopulmonary bypass in children undergoing congenital heart surgery.