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J Thorac Cardiovasc Surg 2002;123:194
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Richard A. Jonas, MD, Jane W. Newburger, MD, MPH, David C. Bellinger, PhD, MSc

Children's Hospital (Boston) Harvard Medical School, Boston, MA 02115

Reply to the Editor

We appreciate the opportunity to comment on the letter by Durandi and associates regarding normothermic cardiopulmonary bypass (CPB) for pediatric cardiac surgery. Although normothermic CPB has some theoretical advantages, a number of important disadvantages exist. Most important, any equipment failure at normothermia leaves very little margin of safety for change of equipment. Because cerebral oxygen consumption is much greater at normothermia, there also is a risk of inadequate oxygen delivery during CPB. In fact, the authors are probably aware that at least one prospective trial of normothermic CPB in adults had to be discontinued because of significantly increased risk of neurologic complications.Go 1 The higher blood flow required with normothermic CPB is of particular concern when a significant number of collateral vessels have developed, as is frequently the case in children with chronic cyanosis. The large amount of left heart return that results obscures the surgeon's vision of the operative field and can compromise the accuracy of repair. Finally, despite improvements in CPB methods, it is possible that the whole-body inflammatory response resulting from CPB is exacerbated by normothermia relative to hypothermia. For all these reasons, we strongly encourage Durandi and associates to collect data, ideally in the form of a prospective randomized trial, comparing hypothermic and normothermic CPB. If such a trial is not possible, the authors should at least accumulate comprehensive outcome data, especially regarding neurologic and developmental status early and late after operations in which normothermic CPB is used.
12/8/120004

Reference

  1. Mora CT, Henson WB, Weintraub WS, Murkin JM, Martin TD, Craver JM, et al. The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization. J Thorac Cardiovasc Surg. 1996;112:514-22.[Abstract/Free Full Text]



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 Eur J Cardiothorac SurgHome page
A. J. Poncelet, M. van Steenberghe, S. Moniotte, T. Detaille, C. Beauloye, L. Bertrand, M.-C. Nassogne, and J. E. Rubay
Cardiac and neurological assessment of normothermia/warm blood cardioplegia vs hypothermia/cold crystalloid cardioplegia in pediatric cardiac surgery: insight from a prospective randomized trial
Eur J Cardiothorac Surg, December 1, 2011; 40(6): 1384 - 1391.
[Abstract] [Full Text] [PDF]

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Right arrow Congenital - acyanotic
Right arrow Congenital - cyanotic
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