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J Thorac Cardiovasc Surg 2001;121:1033-1039
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Pulmonary vascular resistance after cardiopulmonary bypass in infants: Effect on postoperative recovery

Ingram Schulze-Neick, MDa, Jia Li, MDa, Daniel J. Penny, MDb, Andrew N. Redington, MDa

From the Cardiothoracic Unita and the Cardiac Intensive Care Unit,b Great Ormond Street Hospital, London, United Kingdom.

Supported in part by a grant from the SPARKS charity (No. 98/BRM/1).

Received for publication Oct 17, 2000. Revisions requested Nov 8, 2000; revisions received Nov 30, 2000. Accepted for publication Dec 18, 2000. Address for reprints: A. N. Redington, MD, Department of Paediatric Cardiology, Great Ormond Street Hospital, Great Ormond St, London WC1N 3JH, United Kingdom (Email: reding{at}attglobal.net).

Objective: We sought to define the contemporary clinical effect of increased pulmonary vascular resistance in infants after congenital heart operations with cardiopulmonary bypass.
Methods: Fifteen infants (median age, 0.31 years; median weight, 5.1 kg) underwent cardiac operations involving cardiopulmonary bypass (range, 49-147 minutes). Pulmonary vascular resistance was measured in the immediate postoperative period in the intensive care unit by means of the direct Fick principle, with respiratory mass spectrometry to measure oxygen consumption. The effect of ventilation with an inspired oxygen fraction of 0.65, with additional infusion of L-arginine, substance P, and inhaled nitric oxide, was assessed and subsequently correlated with the length of mechanical ventilation from the end of cardiopulmonary bypass to successful extubation.
Results: Overall, pulmonary vascular resistance at baseline (11.7 ± 5.6 WU · m2) could be reduced to a minimum of 6.1 ± 3.5 WU · m2. The ventilatory time was 0.86 to 14.9 days (median, 1.75 days) and correlated directly with the lowest pulmonary vascular resistance value achieved during the pulmonary vascular resistance study (r2 = 0.64, P < .01). The patient subgroup with mechanical ventilation of greater than 2 days had significantly higher pulmonary vascular resistance at all stages of the study protocol, and in this group there was a correlation of cardiopulmonary bypass time and ventilatory support time (r2 = 0.48, P < .05).
Conclusion: Increased pulmonary vascular resistance, either directly or as a surrogate of the systemic inflammatory response after cardiopulmonary bypass, continues to have a significant effect on postoperative recovery of infants after cardiac operations.




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