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J Thorac Cardiovasc Surg 2005;130:1236
© 2005 The American Association for Thoracic Surgery
Editorial |
Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
Received for publication June 14, 2005; accepted for publication July 29, 2005. * Address for reprints: Frank L. Hanley, MD, Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr, CRVB 2nd Floor North, Stanford, CA 94305-5407 (Email: mcharles@lpch.org).
| The first 300 words of the full text of this article appear below. |
Opinions among pediatric heart surgeons vary regarding the routine use of deep hypothermic circulatory arrest (DHCA) during the surgical management of neonates and infants with complex congenital heart disease. Currently, some surgeons use DHCA routinely, others use it selectively, and still others have essentially abandoned the technique, opting for a perfusion strategy that uses continuous cardiopulmonary bypass (CPB). While acknowledging that both DHCA and CPB are abnormal physiologic states associated with risk, surgeons in each camp believe that their particular management scheme provides the best opportunity for morbidity-free outcome. This subject has become controversial in recent years, sometimes it seems to the degree that it is poised to join the ranks of other well-known contentious topics, like religion and politics, which have become increasingly unsuitable for polite and civilized discussion. There are three basic reasons for this development. First, both the quality of cardiac repair and neurodevelopmental status are at issue. High stakes promote controversy. Second, whereas in the past DHCA was a necessity, advances in surgical technique and basic technology have now relegated DHCA to one alternative among several. Having options leads to controversy. Finally, although DHCA generates strong and differing opinions among surgeons, there is not nearly enough factual information to definitively support any one view. Uncertainty invites controversy.
What are the hard data that might assist us in determining the relative efficacy of performing neonatal heart surgery with circulatory support strategies that either incorporate DHCA or use continuous CPB alone? Because the rationale for choosing one support technique over the other is to achieve the best technical repair with the least morbidity, it follows that the pertinent data will relate to two main areas: the quality of the cardiac surgical reconstruction achievable and the total body morbidity that is incurred with each strategy.
The Quality of Cardiac Reconstruction With DHCA and Continuous CPB
The point has been
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