| Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. | |
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MedLine Citation:
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PMID: 7554206 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The neurological morbidity associated with prolonged periods of circulatory arrest has led some cardiac surgical teams to promote continuous low-flow cardiopulmonary bypass as an alternative strategy. The nonneurological postoperative effects of both techniques have been previously studied only in a limited fashion. METHODS AND RESULTS: We compared the hemodynamic profile (cardiac index and systemic and pulmonary vascular resistances), intraoperative and postoperative fluid balance, and perioperative course after deep hypothermia and support consisting predominantly of total circulatory arrest or low-flow cardiopulmonary bypass in a randomized, single-center trial. Eligibility criteria included a diagnosis of transposition of the great arteries and a planned arterial switch operation before the age of 3 months. Of the 171 patients, 129 (66 assigned to circulatory arrest and 63 to low-flow bypass) had an intact ventricular septum and 42 (21 assigned to circulatory arrest and 21 to low-flow bypass) had an associated ventricular septal defect. There were 3 (1.8%) hospital deaths. Patients assigned to low-flow bypass had significantly greater weight gain and positive fluid balance compared with patients assigned to circulatory arrest. Despite the increased weight gain in the infants assigned to low-flow bypass, the duration of mechanical ventilation, stay in the intensive care unit, and hospital stay were similar in both groups. Hemodynamic measurements were made in 122 patients. During the first postoperative night, the cardiac index decreased (32.1 +/- 15.4%, mean +/- SD), while pulmonary and systemic vascular resistance increased. The measured cardiac index was < 2.0 L.min-1.m-2 in 23.8% of the patients, with the lowest measurement typically occurring 9 to 12 hours after surgery. Perfusion strategy assignment was not associated with postoperative hemodynamics or other nonneurological postoperative events. CONCLUSIONS: After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile. |
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Authors:
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G Wernovsky; D Wypij; R A Jonas; J E Mayer; F L Hanley; P R Hickey; A Z Walsh; A C Chang; A R Castañeda; J W Newburger |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Circulation Volume: 92 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1995 Oct |
Date Detail:
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Created Date: 1995-11-14 Completed Date: 1995-11-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2226-35 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Children's Hospital, Boston, MA 02115, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cardiopulmonary Bypass
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adverse effects,
methods* Heart Arrest, Induced* / adverse effects Heart Septal Defects, Ventricular / physiopathology, surgery Hemodynamics / physiology* Hospital Mortality Humans Infant Infant, Newborn Monitoring, Intraoperative Morbidity Postoperative Care Postoperative Complications / epidemiology*, physiopathology, prevention & control Postoperative Period Time Factors Transposition of Great Vessels / physiopathology, surgery* |
| Grant Support | |
ID/Acronym/Agency:
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HL-41786/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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