Comparison Between D 901 L illiput 1 and K ids D 100 Neonatal Oxygenators: Toward Bypass Circuit Miniaturization

• Published in: Artificial organs 2013-01, Vol.37 (1)
• Main Authors: De Rita, Fabrizio, Marchi, Diego, Lucchese, Gianluca, Barozzi, Luca, Dissegna, Roberta, Menon, Tiziano, Faggian, Giuseppe, Mazzucco, Alessandro, Luciani, Giovanni Battista
• Format: Article
• Language: English
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.12017

Progress in biomaterial technology and improvements in surgical and perfusion strategy ameliorated morbidity and mortality in pediatric cardiac surgery. In this study, we describe our clinical experience comparing performance of two neonatal oxygenators. From J anuary 2002 to M arch 2011, 159 infants with less than 5 kg body weight underwent heart surgery. Ninety‐four patients received a D 901 L illiput 1 oxygenator with standard bypass circuit (group A ), while 65 received a D 100 K ids with miniaturized bypass circuit (group B ). Miniaturization consisted in shortened arterial, venous, cardioplegia, and pump‐master lines. Priming composition consisted in Ringer's acetate solution with addition of albumin and blood, with target hematocrit of 24% or greater. In group B cardiopulmonary bypass ( CPB ) was vacuum‐assisted and started with an empty venous line. Modified ultrafiltration and C ell‐ S aver blood infusion was routinely applied in both groups. Average ± standard deviation ( SD ) age at repair was 37 ± 38 days in group A and 59 ± 60 days in group B ( P  = 0.005). Average ±  SD weight, height, and body surface area were 3.5 ± 0.7 kg, 52 ± 4 cm, and 0.22 ± 0.03 m 2 , respectively, in group A, and 3.7 ± 1 kg, 53 ± 5 cm, and 0.23 ± 0.02 m 2 , respectively, in group B ( P  = not significant [ NS ]). Male sex was predominant (55 vs. 58%, P  =  NS ). Priming volume was 524 ± 67 m L (group A ) and 337 ± 53 m L (group B) ( P  = 0.001). There were no statistical differences in hemoglobin at the start, during, and at the end of CPB , but group A required higher blood volume added to the prime (111 ± 33 vs. 93 ± 31 mL, P  = 0.001). In group B , two surgical procedures were completed in total hemodilution. In group B , CPB time and aortic cross‐clamp time were shorter than in group A (106 ± 52 vs. 142 ± 78 min and 44 ± 31 vs. 64 ± 31 min, respectively, P  = 0.001). There were 16 hospital deaths in group A and 4 in group B ( P  = 0.04). Durations of mechanical ventilation and intensive care unit stay were 5.3 ± 3.2 vs. 4.1 ± 3.2 days ( P  = 0.02) and 6.5 ± 4.9 vs. 5.1 ± 3 days ( P  = 0.03), respectively. There were significant differences in inotropic score (1083 ± 1175 vs. 682 ± 938, P  = 0.04) and blood postoperative transfusion (153 ± 226 vs. 90 ± 61 mL, P  = 0.04). Twenty‐seven patients in group A and 10 in group B presented with major adverse postoperative complications ( P  = 0.04). Use of neonatal oxygenators with low priming volume, associated with a mini