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J Thorac Cardiovasc Surg 2005;129:175-181
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Preliminary results of fetal cardiac bypass in nonhuman primates

^a Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, Calif
^b Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Stanford University School of Medicine, Stanford, Calif
^c Department of Surgery, New York University Medical Center, New York, NY
^d Department of Anesthesiology, University of California San Francisco, San Francisco, Calif

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 23, 2004; accepted for publication September 7, 2004.

^* Address for reprints: V. Mohan Reddy, MD, Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University, 300 Pasteur Dr, Falk CVRC, Palo Alto, CA 94305-5407 (E-mail: vmreddy{at}Stanford.edu).

OBJECTIVE: Fetal cardiac surgery has potential benefits for treatment of some congenital heart defects. However, placental dysfunction as a result of fetal bypass, fetal stress, and fetal exposure to external milieu needs to be overcome to optimize the outcomes of fetal cardiac bypass. In this study we evaluated the technical feasibility of cardiac bypass in the nonhuman primate fetus and the efficacy of different anesthetic approaches.

METHODS: Twelve baboon fetuses, average gestation 146 ± 8 days and weight 696 ± 184 g, were used. Three fetuses were excluded from the study because of nuchal cord presentations. The animals were separated into two anesthesia groups: isoflurane (n = 6) and fentanyl and midazolam (n = 3). A miniature roller pump circuit without oxygenator was used for fetal bypass for 30 minutes. No blood transfusion was performed. Fetal blood gas samples were collected before bypass, during bypass, and at 15 and 60 minutes after bypass.

RESULTS: All fetuses in the isoflurane group were successfully placed on the cardiac bypass circuit. However, 2 animals in the fentanyl and midazolam group were not placed on the bypass circuit because of sustained elevation in maternal uterine tone. All maternal baboons survived. Of the 6 fetuses in the isoflurane group, 5 survived for 60 minutes; however, placental function continued to deteriorate after bypass (PaO₂ 33 ± 3 mm Hg before bypass, 23 ± 6 mm Hg 15 minutes after, and 18 ± 9 mm Hg 60 minutes after).

CONCLUSION: The technical feasibility of cardiac bypass in nonhuman primate fetuses weighing less than 1000 g was confirmed. Isoflurane anesthesia appears to be superior to fentanyl and midazolam anesthesia for fetal cardiac surgery because of adequate uterine relaxation.

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