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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Rationale for Implementation of Warm Cardiac Surgery in Pediatrics
1Perfusion Department, CCML, Le Plessis Robinson, France; Intensive Care Department, CCML, Le Plessis Robinson, France.
Insights
Deep hypothermia in cardiac surgery has drawbacks, leading to the development of warm surgery. This technique offers a safe and effective alternative for pediatric cardiac procedures, improving outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
Background:
- Hypothermia and cardiopulmonary bypass revolutionized cardiac surgery in the 1950s, enabling complex repairs.
- Early open-heart surgery focused on reducing mortality and improving short-term outcomes, which were achieved with hypothermia.
- As outcomes improved, the limitations and negative effects of deep hypothermia, particularly on the brain, became evident, prompting the development of regional perfusion and later warm surgery.
Purpose of the Study:
- To outline the limitations of hypothermic protection in pediatric cardiac surgery.
- To explain the rationale behind transitioning to warm pediatric surgery.
- To present warm surgery as a viable alternative to hypothermic techniques.
Main Methods:
- Review of historical cardiac surgical techniques, focusing on hypothermia and its evolution.
- Introduction and implementation of warm surgery principles in pediatric cardiac procedures.
- Analysis of outcomes and reproducibility across multiple centers.
Main Results:
- Deep hypothermia, while essential initially, presents significant drawbacks, especially concerning brain protection.
- Regional perfusion offered limited success in addressing hypothermia's limitations.
- Warm surgery, introduced in the 1990s for adults, proved safe and effective by preventing ischemia-reperfusion injury.
- Transition to warm pediatric surgery demonstrated ease, safety, and efficiency.
Conclusions:
- Hypothermic protection in cardiac surgery has inherent limitations that impact patient outcomes.
- Warm surgery, utilizing continuous systemic coronary perfusion with warm oxygenated blood, effectively mitigates ischemia-reperfusion injury.
- Pediatric warm surgery is a reproducible and valuable alternative to traditional hypothermic methods, supported by extensive clinical experience.
Abstract:
Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia-reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.
