The Annals of thoracic surgery
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Aprotinin use in adults is increasing, and its use in children has recently been reported. ⋯ We conclude aprotinin is an effective means of reducing bleeding, operating time, and donor exposure in infants and children. An increased rate of thrombosis and possibly mediastinitis are potential problems.
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Previous acute studies in immature piglets at our institution have demonstrated improved recovery of cerebral blood flow, intracellular pH, and high-energy phosphates with the administration of multidose University of Wisconsin solution as cerebroplegia during a period of deep hypothermic circulatory arrest (HCA). In an effort to define further the clinical applicability of this technique, we have developed a survival model of swine cardiopulmonary bypass (CPB) and HCA. ⋯ A clinically relevant survival model of CPB with HCA in immature swine is feasible. Cold UW solution as single-dose cerebroplegia is not beneficial, and may be injurious to the immature swine brain subjected to CPB and HCA. Further studies are indicated to determine optimal composition and administration of cerebroplegic solutions.
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Leukocyte filters have been used in cardiopulmonary bypass circuits to decrease potentially deleterious consequences of white blood cell product release in adults undergoing cardiac operations. Studies in animal models have also demonstrated benefits of white blood cell depletion during cardiopulmonary bypass. We sought to examine the efficacy of a leukocyte filter placed in the bypass circuit of infants undergoing operation for correction of congenital heart disease. ⋯ Although these data suggest that the leukocyte filter offers little clinical benefit, a prospective, randomized study should be undertaken to further elucidate the efficacy of leukocyte depletion for infants undergoing cardiopulmonary bypass for correction of congenital heart disease.
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Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
Comparing two strategies of cardiopulmonary bypass cooling on jugular venous oxygen saturation in neonates and infants.
Cerebral protection during deep hypothermic circulatory arrest is predicted on efficient and complete cerebral cooling. Institutions approach cooling quite differently. We compared two different cooling strategies in terms of measured jugular venous bulb saturations in 39 infants undergoing deep hypothermic cardiopulmonary bypass to evaluate the effect of institutional cooling practices on jugular venous bulb saturation, an indirect measure of cerebral cooling efficiency. ⋯ Differences in cardiopulmonary bypass cooling techniques may alter the rate at which jugular bulb saturations rise. We believe this represents an indirect measure of the efficiency of brain cooling and therefore of cerebral protection.
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Randomized Controlled Trial Comparative Study Clinical Trial
Disparity in blood activation by two different heparin-coated cardiopulmonary bypass systems.
Several studies have indicated reduced "blood activation" in heparin-coated cardiopulmonary bypass systems. The present study compares the effect of two different heparin coatings on different blood activation indices. ⋯ Both heparin coatings reduce blood activation, probably more so with Carmeda Biological Active Surface than with Duraflo II.