Affiliation:
1. Penn State Hershey Pediatric Cardiovascular Research Center
Abstract
Abstract
Background: Acyanotic and cyanotic congenital heart disease (CHD) patients are known to have distinct operative risk profiles. However, little is known about whether pulsatile and non-pulsatile cardiopulmonary bypass (CPB) have differential effects on cerebral hemodynamics or outcomes in these two patient groups.
Methods: 159 pediatric (age <18 years) cardiac surgery patients were randomized to pulsatile or non-pulsatile CPB. Patients were stratified by type of CHD: acyanotic versus cyanotic. Intraoperative cerebral gaseous microemboli counts and middle cerebral artery pulsatility index were assessed. Postoperative organ injury was quantified by Pediatric-Logistic-Organ-Dysfunction (PELOD-2) score at 24, 48, and 72 hours. Additional outcomes included Pediatric Risk-of-Mortality 3 (PRISM 3) score, vasoactive-inotropic score, duration of mechanical ventilation, intensive care and hospital length-of-stay, and mortality within 180 days.
Results: Regional-cerebral-oxygen-saturation, gaseous microemboli counts, and mean arterial pressure were similar between groups. PELOD-2 scores decreased over time, with similar scores between perfusion modalities in either group. Analysis of additional postoperative outcomes revealed no significant differences between non-pulsatile and pulsatile perfusion in either acyanotic or cyanotic groups.
Conclusions: Despite patients undergoing pulsatile CBP demonstrating a more physiologic pulsatility index in both acyanotic and cyanotic groups, no clinically significant differences in cerebral hemodynamics or clinical outcomes were appreciated.
Trial Registration Number and Registration Date: NCT00862407 (16/03/2009) (first registration date)
Publisher
Research Square Platform LLC
Reference23 articles.
1. STS Congenital Heart Surgery Data Summary – All Patients. https://www.sts.org/sites/default/files/Congenital-STSExecSummary_AllPatients.pdf (2022).
2. Persistent Markers of Kidney Injury in Children Who Developed Acute Kidney Injury After Pediatric Cardiac Surgery: A Prospective Cohort Study;Eynde J;JAMA,2022
3. Preoperative prediction of acute kidney injury––from clinical scores to biomarkers;Zappitelli M;Pediatr. Nephrol.,2013
4. Cardiopulmonary bypass-induced myocardial reoxygenation injury in pediatric patients with cyanosis;Modi P;J. Thorac. Cardiovasc. Surg.,2002
5. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association;Marino BS;Circulation,2012