Evaluation of Normothermic Pediatric Open Heart Surgery Outcomes

Abstract

Background & Aim: there are multiple methods of hypothermia in pediatric open heart surgery. The safety of warm perfusion (normothermic pediatric open heart surgery with warm blood cardioplegia) remains controversial. This study evaluates the safety of warm perfusion (normothermic pediatric open heart surgery with intermittent warm blood cardioplegia) compared with the classic hypothermic one (hypothermic pediatric open heart  surgery with cold blood cardioplegia).

Material and Methods:This cohort prospective study includes 158 infants in Cardiac Surgery Hospital at Damascus University from 01-01-2015 to 01-01-2019, divided into two groups. Group A includes 85 infants who underwent a warm perfusion (normothermic open heart surgery with warm blood cardioplegia), and group B includes 73 patients who underwent a hypothermic perfusion (moderate hypothermic open heart surgery with cold blood cardioplegia). In both groups the patients were chosen for operations that needed cross clamp time less than sixty minutes. The results were analyzed and compared with other studies.

Results:Comparing group A with group B, mortality rate was 0% in both groups. Intubation time (hours) was 6.5 ± 2.3 in group A versus 11.3 ± 3.5 in group B. Length of intensive care unit stay was    41 ± 15 hours in group A versus 51 ± 21 hours in group B.The need of inotropes was for 3 patients in both groups. There was no organ failure in the two groups. There was no bleeding in group A, versus 2 cases of bleeding in group B . After cross clamp removal, the heart was beating spontanuasely in all patients of group A exept one patient needed  a shock , while 3 patients needed a shock in group B. Lactate concentration was not high in both groups during surgery and it remained so after surgery.

Conclusion:There were minimal differences between the results of group A and B with a slight advantage for group A, so we had good results, and were comparable with those in the literature. This led to the conclusion that warm perfusion in pediatric open heart surgery (normothermia  with warm blood cardioplegia) is safe when cross clamp time  is less than sixty minutes .