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Background: Deep hypothermic circulatory arrest or deep hypothermia with reduced flow CPB is frequently used during pediatric procedures. Unfortunately, in many instances these perfusion techniques are associated with adverse neurologic, renal, or inflammatory (corporeal edema) responses that are rarely observed in adult or older pediatric patients undergoing CPB with mild hypothermic (32c) full flow CPB (MHFFCPB). Modern perfusion equipment now allows for the routine use MHFFCPB for virtually all pediatric patients save those requiring a Norwood procedure.
Methods: 250 consecutive open/arrested pediatric cases excluding Norwood procedures using MHFFCPB were reviewed. Age ranged from 1 day to 18 years, there were 28 neonates. Neonatal procedures included ASO, VSD-IAA, TAPVC, TrArt, AVC-IAA, PA-MAPCAs, etc. Weight ranged from 1.7Kg to 90Kg, with 67 patients 5Kg or less. CPB time ranged from 25- 393 minutes. Cross-clamp times ranged from 14-229 minutes and all-blood cardioplegia was used for every patient.
Results: There were 5 deaths (2.0%). One patient required an assist device (0.4%). Only 2 patients required peritoneal or hemodialysis (0.8%). One survivor suffered a neurological event (0.4%). High dose inotropic support was needed in 20 patients (8%) to avoid or treat low cardiac output syndrome.
Conclusion: With modern perfusion equipment virtually all pediatric patients save Norwood candidates may be treated using MHFFCPB. Clinical outcomes are excellent and neonatal/low weight patient’s (<5Kg) physiologic response to MHFFCPB is similar to that of adults and older children. This data suggests that the routine use of systemic hypothermia for pediatric cardiopulmonary bypass is not necessary.