Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group (n = 63, 40 mL/kg < HTK ≤ 60 mL/kg) and a high-dose (HD) group (n = 83, HTK >60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias.The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P < 0.0001), a lower proportion of complete transposition of the great artery (69.8% vs. 85.5%, P = 0.022), a lower cardiopulmonary bypass (CPB) time (123.5 [108.0, 136.0] vs. 132.5 [114.8, 152.5] min, P = 0.034), and a lower aortic x-clamp time (82.9 ± 27.1 vs. 95.5 ± 26.0 min, P = 0.005). After PSM, 44 patients were assigned to each group; baseline characteristics and CPB parameters between the two groups were comparable. There were no significant differences in peri-CPB blood product consumption after PSM (P > 0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay (P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.
Objective To investigate the blood protective effect of continuous auto transfusion system(CATS)on packed red cells during neonatal cardiac surgery.Methods From December 2006 to December 2008,36 neonates undergoing cardiac surgery were divided to control group(group Ⅰ,n=18) and test group(group Ⅱ,n=18).Levels of hematocrit,blood potassium,blood glucose and lactate in the packed red cells of CATS treated group(group Ⅱ) and nontreated group(group Ⅰ) were measured.And the different levels of hematocrit,lactate and the total priming volume of packed red cell were compared,and the urine volume and colour changes in the two groups at different time points were also observed.Results Before CPB,the hematocrit in groupⅡ was significantly higher than that of group Ⅰ(P0.01),and the level of potassium,blood glucose and lactate were significantly lower than those of group Ⅰ(P0.01).At the beginning and the end of CPB,the hematocrit in group Ⅱ were higher than those of group Ⅰ,and the level of lactate in group Ⅱ was significantly lower than that of group Ⅰ.The total priming of PRBC in group Ⅱ was less than group Ⅰ.Conclusion CATS can improve the quality of old stored blood and decrease the total priming of PRBC,and provide blood protection during neonatal cardiopulmonary bypass.
Cardiac surgery in patients undergoing cardiopulmonary bypass (CPB) provokes a vigorous inflammatory response with substantial clinical implications. Once the inflammatory response is triggered by CPB, leukocytes and platelets are activated by multiple stimuli. The administration of a urinary trypsin inhibitor (ulinastatin) during CPB is hypothesized to reduce cytokine release and platelet activation and to decrease pulmonary injury. We performed a prospective randomized study to investigate the influence of high-dose ulinastatin on cytokines and platelet activation and on respiratory function during and after CPB.In this pilot, prospective, randomized and double-blinded study, 30 first-time three-vessel coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) were randomly divided into 2 groups: U group (n=15) received a total dose of 1000000 U ulinastatin and C group (n=15) received placebo. Blood samples were withdrawn from the central vein to measure polymorphonuclear neutrophil elastase (PMNE), tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-8 (IL-8), before induction, 30 min following clamping (T2), reperfusion 3 h (T3), reperfusion 6 h (T4) and reperfusion 12 h (T5). Whole blood samples were taken for CD62P immediately before induction (as baseline), at the end of CPB (before protamine administration), 1 h after heparin neutralization by protamine and 24 h after the operation. In addition, alveolo-arterial oxygen difference (A-aDO(2)) in pulmonary gas exchange function was calculated by obtaining arterial blood gas samples before and after CPB.There were no differences in preoperative parameters between the groups. After CPB, the levels of PMNE, TNF-alfa, IL-6 and IL-8 increased in both groups over baseline values (P<0.01). The levels of PMNE, TNF-alfa, IL-6 and IL-8 in U group were significantly lower than those in C group (P<0.05). No significant differences in CD62p expression between the 2 groups during CPB were found. A-aDO(2) in U group significantly decreased compared with C group (P<0.05) and the duration of mechanical ventilation was shorter than C group (P<0.05).Results suggest that ulinastatin may inhibit proinflammatory cytokine (PMNE, TNF-alfa, IL-6 and IL-8) release, reduce reperfusion lung injury and preserve pulmonary function but it fails to inhibit platelet activation and to prevent blood loss during CPB.
Objective To summarize and analyse the files of consecutive 12 pediatric ECMO performed in Fuwai Cardiovascular Hospital retrospectively.Methods We reviewed the clinical protocols of 12 pediatric ECMO before and after cardiac surgery from Dec.2004 to Dec.2005 in our hospital.ECMO equipments of Medtronic Ltd were utilized to every patient and the inter-surface of the system was covered completely by heparin-coating technique.All patients applied veno-artery ECMO and active clotting time(ACT) maintained between 146～258sec and heparin usage dose was 5～20?U/(kg·h).Mean blood flow was 40～220?ml/(kg·min) during ECMO assistant period.Results The shortest ECMO time was 55h and longest 266h and mean time 120h.ECMO were weaned off successfully in 9 patients(75%) and 6 of them(67%) were survival to discharged and 3 of them were died of post-operation complications.Three patients could not been weaned off ECMO.Total survival discharge rate was 50%(6/12) in this cohort study.Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients(P=0.022).Weights between the survival and the dead also had statistic difference(P=0.019).Conclusions ECMO is an effective mechanical assistant therapy for cardiac and pulmonary failure patients after cardiac surgery with pediatric complicated congenital heart disease and ECMO can be used as a bridge for heart transplantation to those severe end-stage heart disorder in children.Perfect correction of abnormality and earlier usage of ECMO for cardiac and respiratory failure patients and avoiding the main organs from un-recovery trauma are still the key of success of ECMO.
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