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Eur J Cardiothorac Surg 2007;31:754-755. doi:10.1016/j.ejcts.2007.01.015
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Warm surgery: our experience

Vincenzo Cassanoa, Leonardo Milellab,*

a Department of Paediatric Cardiac Surgery, Paediatric Cardiac Surgery Unit, Paediatric Hospital Giovanni XXIII, Azienda Policlinico-Giovanni XXIII, Piazza G.Cesare 11, Bari, Italy
b Cardiac Surgery Anaesthesia and Intensive Care Unit, Paediatric Hospital Giovanni XXIII, Azienda Policlinico-Giovanni XXIII, Piazza G.Cesare 11, Bari, Italy

Received 20 November 2006; accepted 15 January 2007.

* Corresponding author. Address: Paediatric Cardiac Anaesthesia and Intensive Care Unit, Ospedale Pediatrico Giovanni XXIII, 70121 Piazza G.Cesare, no. 11, Bari, Italy. Tel.: +39 080 5595109; fax: +39 080 5595109. (Email: lemilel{at}tin.it).

Key Words: Paeditric cardiac surgery • Normothermic perfusion

We read with great interest the article ‘Normothermic cardiopulmonary by-pass and miocardial cardioplegia protection for neonatal arterial switch operation’ [1] by Pouard et al. [European Journal of Cardiothoracic Surgery; 30 (2006) 695–699].

The authors are to be congratulated for their warm approach to neonatal cardiac surgery while anywhere in the world the cold approach still remains the daily choice.

We have been happy to read about the experience of Dr Pouard because we have had in the recent past a short experience in our Peadiatric Cardiac Surgery and Intensive Care Unit Department, performing the same type of procedures in neonate and paediatric patients [2].

From February 1997 to May 1997, 19 patients underwent warm cardiopulmonary by-pass surgery and intermittent cold cardioplegia.

This approach was supported by our anaesthesiologist and intensivist, who already had a previous similar experience during a working period as Consultant Paediatric Anaesthesist at Health Care International Medical Center, Clydebank, Glasgow, UK [3,4].

The age of our patients was 8 days–10 years, mean age was 1,5 years; the body weight was 2.1–36 kg, mean weight 11 kg.

There were six cyanotic patients (TOF 2; TOF + absent pulmonary valve 1, left isomeric syndrome 2; pulmonary atresia with intact septum 1) and 13 non-cyanotic patients (ASD 3; ASD + pulmonary stenosis 1; VSD 4; VSD + pulmonary stenosis 2; partial anomalous venous pulmonary return 1; complete AV canal 1; partial AV canal 1).

Anaesthesia was performed with TIVA (Midazolam, Ketamine, Vecuronium); cardiopulmonary by-pass temperature was 37 °C and by-pass flow was 3 l/m2/min with intermittent cristalloid cold cardioplegia.

To control the venous return we used venous cannulas produced from Sofracob® that allowed us to maintain a full flow during the entire procedure, and a complete dry surgical field.

In agreement with Dr Pouard, we confirm no neurological disorder and renal failure with a short time of ventilation and intubation (84% was extubated within 6 h after surgery according to a procedure of Fast-Track anaesthesia) and a shorter length stay in ICU [4].

We noted a reduction in the use, dosage and duration of infusion of inotropic drugs and vasodilators [3,4].

We also noted a reduction of blood loss in warm surgery (0.2–2.1 ml/kg/h) with respect to cold surgery (mean loss of 3.58 ml/kg/h) [5].

In conclusion, warm CPB:

• in neonate and paediatric patients is feasible and safe;
• allows the reduction of inotropic support;
• gives a miocardial rapid recover;
• reduces ventilation and intubation time;
• reduces the stay length in ICU with a reduction of surgery costs;
• reduces the blood loss in the first 6 h from the end of surgery;

We discontinued this technique because at the time we started it there was no literature supporting this way of performing paediatric cardiac surgery, and we felt too much pioneering, but reading today the article of Dr Pouard makes us sure that we were not so far from using a correct new approach.

References

  1. Pouard P, Mauriat P, Ek F, Aydar A, Gioanni S, Laquay N, Vaccaroni L, Vouhe P. Normothermic cardiopolmonary bypass and myocardial cardioplegic solution protection for neonatal arterial switch operation. Eur J Cardiothorac Surg 2006;30:695-699.[Abstract/Free Full Text]
  2. Milella L, Cassano V, Mondelli V, Meleleo R, Balena R, Mele D, Arciprete P. Normothermic cardiopulmonary by-pass in paediatric cardiac surgery: a new frontier?. CARACT 1997, IV Course of Cardiothoracic Anaesthesia and ICU Treatment. Milan, Italy, November 28–29. 1997.
  3. Corno AF, Milella L, Da Cruz E, Wilson N. Normothermic cardiopulmonary by-pass in paediatric cardiac surgery. The American Association of Thoracic Surgery1997 Annual Meeting. Washington, DC, May 4–7. 1997.
  4. Milella L, Da Cruz E, Gajraj R, Corno AF. Computerized anaesthesia and normothermic perfusion in paediatric cardiac surgery. The Second World Congress of Pediatric Cardiology and Cardiac Surgery. Honolulu-Haway, May 11–15. 1997p. 376, Abstract.
  5. Meleleo R, Milella L, Mondelli V, Cassano V, Mele D, Arciprete P. Post-operative blood loss reduction: is an advantage of normothermic cardiopulmonary by-pass?. CARACT 1997, IV Course of Cardiothoracic Anaesthesia and ICU Treatment. Milan, Italy, November 28–29. 1997.



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Home page
 Eur. J. Cardiothorac. Surg.Home page
P. Pouard
Reply to Cassano and Milella
Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 755 - 755.
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