Pediatric warm open heart surgery and prolonged cross-clamp time

Area of Science:

• Pediatric Cardiac Surgery
• Cardiovascular Surgery
• Cardiopulmonary Bypass

Background:

• The safety of normothermic pediatric cardiac surgery is debated.
• This study investigates normothermic cardiopulmonary bypass (CPB) with warm blood cardioplegia during extended aortic cross-clamp times (CCT).

Purpose of the Study:

• To evaluate the safety and performance of normothermic CPB with intermittent warm blood cardioplegia in pediatric patients undergoing prolonged aortic cross-clamp time.
• To compare outcomes of pediatric cardiac surgery with extended CCT to those with shorter CCT.

Main Methods:

• Retrospective analysis of 234 pediatric patients (<10 kg) undergoing CPB.
• Patients were divided into two groups: prolonged CCT (>90 minutes, n=38) and shorter CCT (n=196).
• Outcomes were compared with the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery database.

Main Results:

• Prolonged CCT group showed higher rates of mortality (5.3% vs 2%), delayed chest closure (21% vs 2.6%), and organ failure (13% vs 2%).
• Extended CCT also correlated with longer hospital stays, intensive care unit stays, and extubation times.
• Despite differences, results were within literature ranges, indicating safety.

Conclusions:

• Normothermic pediatric cardiac surgery with a prolonged aortic cross-clamp time is deemed safe.
• Outcomes, while showing expected differences, remain within acceptable ranges.
• Further large-scale, randomized trials comparing normothermic and hypothermic approaches are ongoing.