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HERDIN Record #: PCHRD090107020914 Submitted: 02 September 2007

In-hospital clinical outcome in congenital open heart surgery at various cardiopulmonary bypass temperature levels and ischemic times .

Karyn P. Luna

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Congenital heart disease poses numerous variables such as aortopulmonary shunts, myocardial maturity, etc. These factors should be considered in planning for adequate myocardial preservation. Myocardial protective techniques used in adults are uncritically extended in pediatric surgery with significant morbidities and mortalities. It is with this premise that the in-hospital clinical events are compared between different levels of CPB temperatures at different ischemic times both among acyanotic and cyanotic congenital open heart surgery.

Methods and ResultsÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ All charts of patients aged 0-19 years old who underwent elective congenital open heart surgery starting January 2000 to December 2004 were reviewed. Acyanotic and cyanotic patients were further categorized into four CPB temperature levels as normothermia (>/= 34 C), mild hypothermia (32 C to 33.9 C), moderate hypothermia (28 C to 31.9 C), and deep hypothermia ( 18 C to 27.9 C). No patient underwent profound hypothermia at a temperature range of 15 C to 17.9 C. Further division was based on duration of crossclamp time as group I at 30 minutes to 60 minutes, group II at 61 minutes to 120 minutes, group III at 121 minutes to 180 minutes, and group IV at more than 180 minutes.

A total of 528 patients were included in the study. Acyanotic patients were 334 and cyanotic patients totaled 194. Normothermia patients were 70 (acyanotic n=38, cyanotic n=32). Mild hypothermia were 224 cases (acyanotic n=167, cyanotic n=57). Moderate hypothermia cases were 203 (acyanotic n=lll, cyanotic n=92). Deep hypothermia were 31 cases (acyanotic n=18, cyanotic n=13).

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ For cross clamp time reaching 120 minutes, both acyanotic and cyanotic patients presented with better in-hospital outcome with mild hypothermia. Beyond 120 minutes of ischemic time, there was no significant difference as to in-hospital morbidities among acyanotic and cyanotic patients. However, acyanotic patients subjected to mild hypothermia had high mortality rate and better survival with moderate hypothermia. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
January-March 2006
Volume
12
Issue
1
Page(s)
14-23
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)