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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 362-368, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RA Jonas, DC Bellinger, LA Rappaport, G Wernovsky, PR Hickey, DM Farrell and JW Newburger
To examine whether pH management during core cooling is a risk factor for
adverse developmental outcome, we studied 16 children with transposition of
the great arteries and intact ventricular septum who underwent a Senning
procedure in infancy (median age 32 days, range 2 to 154 days) between 1983
and 1988. Information was collected retrospectively on many aspects of
perfusion, including lowest carbon dioxide tension during core cooling,
duration of core cooling, and duration of circulatory arrest. The pH
strategy changed from pH-stat to alpha-stat in 1985, resulting in a wide
range of pH values and carbon dioxide tension (34 to 76 mm Hg) during the
study period. All children had rapid core cooling to a rectal temperature
of 19.8 degrees +/- 2.7 degrees C (mean +/- standard deviation) and a
tympanic temperature of 16.6 degrees +/- 3.0 degrees C. Development was
assessed at median age 48.0 (11 to 79) months with the Bayley Scales (n =
4, children younger than 30 months) or the McCarthy Scales (n = 12,
children older than 30 months). The mean core-cooling duration was 14.5 +/-
6.2 minutes, circulatory arrest time was 43.4 +/- 6.6 minutes, and total
bypass plus circulatory arrest time was 89.7 +/- 12.7 minutes. Lower carbon
dioxide tension (alpha-stat) before onset of circulatory arrest was
associated with worse developmental outcome (r = 0.71, p = 0.002). This
relationship remained highly significant when we controlled for
sociodemographic and intraoperative variables. including core-cooling time,
circulatory arrest time, and total elapsed time. Duration of circulatory
arrest was not associated with developmental outcome. We conclude that when
relatively rapid core cooling is used to achieve hypothermia before
circulatory arrest in young infants, a more alkaline pH strategy such as
alpha-stat may result in less effective cerebral protection.
ARTICLES
Relation of pH strategy and developmental outcome after hypothermic circulatory arrest
Department of Cardiac Surgery, Children's Hospital, Boston, MA 02115.
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T. Juvonen, V. Anttila, J. Rimpilainen, M. Pokela, V. Vainionpaa, and K. Kiviluoma Reply J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 597 - 598. [Full Text] [PDF]
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M. A. Priestley, J. A. Golden, I. B. O'Hara, J. McCann, and C. D. Kurth Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0336 - 343. [Abstract] [Full Text] [PDF]
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R. A Jonas Optimal pH strategy for cardiopulmonary bypass in neonates, infants and children Perfusion, December 1, 1998; 13(6): 377 - 387. [PDF]
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A. J. du Plessis, R. A. Jonas, D. Wypij, P. R. Hickey, J. Riviello, D. L. Wessel, S. J. Roth, F. A. Burrows, G. Walter, D. M. Farrell, et al. PERIOPERATIVE EFFECTS OF ALPHA-STAT VERSUS pH-STAT STRATEGIES FOR DEEP HYPOTHERMIC CARDIOPULMONARY BYPASS IN INFANTS J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 991 - 1001. [Abstract] [Full Text]
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H. H. Hovels-Gurich, M.-C. Seghaye, S. Dabritz, B. J. Messmer, and G. von Bernuth COGNITIVE AND MOTOR DEVELOPMENT IN PRESCHOOL AND SCHOOL-AGED CHILDREN AFTER NEONATAL ARTERIAL SWITCH OPERATION J. Thorac. Cardiovasc. Surg., October 1, 1997; 114(4): 578 - 585. [Abstract] [Full Text]
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A. A. Zimmerman, F. A. Burrows, R. A. Jonas, and P. R. Hickey THE LIMITS OF DETECTABLE CEREBRAL PERFUSION BY TRANSCRANIAL DOPPLER SONOGRAPHY IN NEONATES UNDERGOING DEEP HYPOTHERMIC LOW-FLOW CARDIOPULMONARY BYPASS J. Thorac. Cardiovasc. Surg., October 1, 1997; 114(4): 594 - 600. [Abstract] [Full Text]
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 A. J. du Plessis Topical Review: Cerebral Hemodynamics and Metabolism During Infant Cardiac Surgery. Mechanisms of Injury and Strategies for Protection J Child Neurol, August 1, 1997; 12(5): 285 - 300. [Abstract] [PDF]
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F. H. Kern, R. M. Ungerleider, S. R. Schulman, J. N. Meliones, R. M. Schell, B. Baldwin, P. R. Hickey, M. F. Newman, R. A. Jonas, and W. J. Greeley Comparing Two Strategies of Cardiopulmonary Bypass Cooling on Jugular Venous Oxygen Saturation in Neonates and Infants Ann. Thorac. Surg., November 1, 1995; 60(5): 1198 - 1202. [Abstract] [Full Text]
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J. M. Murkin The Role of CPB Management in Neurobehavioral Outcomes After Cardiac Surgery Ann. Thorac. Surg., May 1, 1995; 59(5): 1308 - 1311. [Abstract] [Full Text]
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W. Cheng, J. F. Hartmann, D. E. Cameron, E. M. Griffiths, J. R. Kirsch, and R. J. Traystman Cerebral Blood Flow During Cardiopulmonary Bypass: Influence of Temperature and pH Management Strategy Ann. Thorac. Surg., April 1, 1995; 59(4): 880 - 886. [Abstract] [Full Text]
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