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Eur J Cardiothorac Surg 2007;31:755. doi:10.1016/j.ejcts.2007.01.016
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Cassano and Milella

Departments of Anesthesiology and Pediatric Cardiac Surgery, Hopital Necker-Enfant Malades, 49 rue de Sevres, 75007 Paris, France

Received 11 January 2007; accepted 15 January 2007.

^_* Corresponding author. Tel.: +33 144 381903; fax: +33 144 381906. (Email: ppouard.laennec{at}invivo.edu).

Key Words: Cardiopulmonary bypass • Congenital heart disease • Pediatric • Perfusion • Surgery

We thank Dr Cassano and Milella to share their experience and preliminary results about normothermic perfusion in pediatric cardiac surgery [1]. Nevertheless, as described in our article [2], we would like to point out the differences between our two techniques. The main difference seems essential and affects the myocardial protection. In their experience Cassano and Milella used a cold cardioplegic solution associated with a warm CPB perfusion. In our experience, we thought that, due to the size of the myocardium, the risk of a fast rewarming of the myocardium would be too hazardous, and that it was logical to perfuse the heart at the same temperature than the body; and as a consequence to decrease the delay between the intermittent cardioplegic perfusions. The second difference lies in the monitoring, it is essential to assess the adequacy of perfusion directly on lines to avoid any discrepancy between oxygen demand and delivery at any time. If we both found a reduction in intubation, ventilation time, and ICU length of stay, it is less clear about the reduction of bleeding and transfusion (depending also on surgery, anesthesia and pharmacological manipulations of haemostasis), and it has not yet been proven [3]. The main point remaining to assess is the long-term neurological outcome. For the short-term neurological outcome, the use of near infrared spectroscopy during CPB has not shown brain desaturation, EEG disorders and clinical examination before the discharge from hospital have not shown neurological disorders.

References

1. Cassano V, Milella V. Eur J Cardiothorac Surg 2007;31:754-755.[Free Full Text]
2. Philippe Ph, Mauriat P, Ek F, Haydar A, Gioanni S, Laquay N, Vaccaroni L, Vouhe PR. Normothermic cardiopulmonary bypass and myocardial cardioplegic protection for neonatal arterial switch operation. Eur J Cardiothorac Surg 2006;30:695-699.[Abstract/Free Full Text]
3. De Leval MR. Because we can, should we ...?. Eur J Cardiothorac Surg 2006;30:693-694.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pouard, P. Search for Related Content PubMed Articles by Pouard, P. Related Collections Anesthesia Congenital - acyanotic Congenital - cyanotic Extracorporeal circulation