POSTOPERATIVE COURSE AND HEMODYNAMIC PROFILE AFTER THE ARTERIAL SWITCH OPERATION IN NEONATES AND INFANTS - A COMPARISON OF LOW-FLOW CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST
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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DOI：
10.1161/01.cir.92.8.2226
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发表时间：
1995-10-15
期刊：
影响因子：
37.8
通讯作者：
WESSEL, DL
中科院分区：
文献类型：
--
作者：
WERNOVSKY, G;WYPIJ, D;WESSEL, DL
背景与长时间循环停搏相关的神经系统疾病导致一些心脏外科团队将持续低流量体外循环作为替代策略。这两种技术的非神经术后影响以前只在有限的fashion.Methods和结果进行了研究，我们比较了血液动力学的配置文件（心脏指数和全身和肺血管阻力），术中和术后液体平衡，和围手术期后深低温和支持主要包括全循环停搏或低流量体外循环在一个随机的，单中心试验。入选标准包括诊断为大动脉转位和计划在3个月大之前进行动脉转换手术。在171例患者中，129例（66例分配到循环停搏，63例分配到低流量旁路）室间隔完整，42例（21例分配到循环停搏，21例分配到低流量旁路）有相关的室间隔缺损。有3例（1.8%）住院死亡。与循环停止组患者相比，低流量旁路组患者的体重增加和正液体平衡显著更大。尽管分配到低流量旁路的婴儿体重增加，但两组的机械通气持续时间、重症监护室停留时间和住院时间相似。对122例患者进行了血流动力学测量。术后第一个晚上，心脏指数下降（32.1 ± 15.4%，平均值± SD），而肺和全身血管阻力增加。测得的心脏指数为
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