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Comparison of two different extracorporeal circuits on cerebral embolization during cardiopulmonary bypass in children

Department of Surgery, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada

Dean Belway

Department of Cardiovascular Perfusion, University of Ottawa Heart Institute, Ottawa, Canada

Objective: To compare the effect of two different extra-corporeal circuits on the counts of high-intensity transient signals (HITS) during pediatric cardiopulmonary bypass (CPB). Methods: Transcranial Doppler was used to detect HITS associated with extracorporeal sources during the period of aortic crossclamping in the middle cerebral artery of children undergoing CPB. Based on body size, children were assigned one of two extracorporeal circuits (A or B). Circuit A included a D-705 oxygenator and associated reservoir, and circuit B included a Lilliput oxygenator and reservoir. Patients were further classified into two groups according to the complexity of surgical repair: single simple lesions or multiple complex lesions. Results: We studied 109 pediatric patients. Surgery for multiple complex lesions was associated with longer periods of aortic crossclamping and CPB (p <0.0001). The median count of extra-corporeal HITS was 12 (25th, 75th percentiles: 3, 51). The type of extracorporeal circuit (p=0.012) and the complexity of surgical repair (p <0.0001) had an effect on the HITS counts. The use of circuit A was associated with higher HITS counts during surgery for multiple complex lesions compared to single simple lesions (p <0.0001). Conversely, no differences were found with the use of circuit B between these two surgical groups (p >0.25). During surgery for multiple complex lesions, patients treated with circuit A showed higher HITS counts than those with circuit B (p <0.01), but there were no circuit-related differences in HITS counts (p=0.30) during single simple lesions. Conclusion: Variations in the design characteristics of extracorporeal circuits can increase cerebral emboli during CPB in children. This may be related to the reduced ability of some circuits to remove emboli during long periods of CPB for complex congenital heart-surgery.

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Perfusion, Vol. 21, No. 5, 247-253 (2006)
DOI: 10.1177/0267659106074764


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Rodriguez, R. A Articles by Belway, D. Search for Related Content PubMed PubMed Citation Articles by Rodriguez, R. A Articles by Belway, D. Social Bookmarking                         What's this?