Open-heart surgery in infants using pulsatile high-flow cardiopulmonary bypass

Pulsatile high-flow cardiopulmonary bypass (2.5 l/m2/min with a rectal temperature of 28 degrees C) combined with the Pulsatile Bypass Pump (Kontron Instrument) has been used at Fukuoka Children's Hospital in 259 cases of open-heart surgery in patients less than 1 year of age for a period of 5 years beginning July 1982. The overall results were satisfactory with a surgical mortality of 6.2% (VSD: 96 cases/2 deaths, TGA: 48/1, TAPVD: 34/3, Complete ECD: 15/1, IAA: 10/1, DORV: 10/1, HLHS: 7/4, TOF: 6/0, Truncus Art: 5/0, Others 28/3). The mean duration of cardiopulmonary bypass was 123 +/- 50 minutes during which time the patients had a positive water balance of only 28 +/- 38 ml per kg of body weight. The lowest positive water balance was noted in the patient group with 60-75 mmHg in peak systolic pressure and 30-45 mmHg pulse pressure divided by the pulsatile wave form. This value was significantly lower than other groups of patients with lower or higher peak systolic and pulse pressures. Urinary output during the first 24 hours after operation was 4.1 +/- 1.3 ml/kg/hour. Weight gain on the first postoperative day was 10 +/- 43 g per kg of body weight, and the duration of postoperative respiratory support was 4 +/- 5 days. In conclusion, pulsatile high-flow cardiopulmonary bypass is useful in infant open-heart surgery in light of operative techniques, water balance and postoperative recovery.