Less Invasive Cardiopulmonary Bypass System In Neonates And Small Infants
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Objective:
In neonates and small infants, the surface area of the cardiopulmonary bypass (CPB) circuit, relative to the patients' blood volume, is much higher than in adults. Cardiopulmonary bypass in children is associated with a capillary leak due to inflammatory response, which results in an increase in total body water (systemic edema) after CPB. In our institution, the priming volume has been reduced from 500 ml in the year 2000 to 140 ml currently. We have established a low priming volume CPB system using biocompatible poly (2-methoxyethylacrylate) (PMEA) coated circuits. This study was designed to reveal that our bypass system reduced the perioperative systemic inflammatory response in neonates and small infants.
Methods:
Fifty-one consecutive patients weighing less than 5 kg with a bypass time of more than 100 minutes were retrospectively reviewed. The postoperative peak C-reactive protein (CRP) and body weight gain (percentile of body weight, %BWG) data were collected as the perioperative inflammatory response for each patient. The data of priming volume (mean 206 +/- 71 ml, range 140-500), biocompatibility of CPB circuits (coated: 15, uncoated: 36), bypass time (mean 166 +/- 46 min, range 100-330), body weight (mean 3.3 +/- 0.9 kg, range 1.1-4.9), the complexity of procedure (Comprehensive Aristotle Score, mean: 3.2 +/- 0.9, range 1-4) were collected for all patients. Stepwise multiple logistic regression analysis was used to investigate which of the factors most affected the perioperative inflammatory responses.
Results:
The peak CRP in patients with PMEA coated circuits was significantly lower than taht in patients without (4.09 +/- 0.89 vs 8.39 +/- 0.89 mg/dl, p < 0.01). The peak CRP and %BWG in patients with a priming volume of more than 200 ml were significantly greater than those in patients with less than 200 ml (CRP: 9.72 +/- 4.83 vs 6.05 +/- 5.10 mg/dl, p < 0.05, %BWG: 5.0 +/- 3.4 vs 2.5 +/- 3.3%, p < 0.05, respectively). A combination of PMEA coated circuits use (coefficient: -4.36, 95%; confidence interval -7.25 - -14.7, p = 0.004), and patient's body weight (coefficient: 1.48, 95%; confidence interval 0.10 - 2.86, p = 0.036) most affected the postoperative peak CRP (mg/dl). A combination of priming volume (coefficient: 0.021, 95%; confidence interval 0.009 - 0.032, p = 0.001), and bypass time (coefficient: 0.038, 95%; confidence interval 0.020 - 0.056, p = 0.001), most affected %BWG.
Conclusions:
The miniaturized PMEA coated circuits reduced the perioperative inflammatory response in neonates and small infants. Using our bypass system, it is possible to do complex procedures safely and less invasively for patients weighing less than 5 kg.
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