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Neonatal cardiopulmonary bypass—a review of current practice in North America

Published online by Cambridge University Press:  19 August 2008

Robert C. Groom*
Affiliation:
From the Virginia Heart Center, Falls Church and The University of Texas Medical Branch, Galveston
Aaron G. Hill
Affiliation:
From the Virginia Heart Center, Falls Church and The University of Texas Medical Branch, Galveston
Bechara Akl
Affiliation:
From the Virginia Heart Center, Falls Church and The University of Texas Medical Branch, Galveston
Mark Kurusz
Affiliation:
From the Virginia Heart Center, Falls Church and The University of Texas Medical Branch, Galveston
Edward A. Lefrak
Affiliation:
From the Virginia Heart Center, Falls Church and The University of Texas Medical Branch, Galveston
*
Mr. Robert C. Groom, Perfusion Department, Cardiac Surgery, Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22046, USA. Tel. 703-698-3728; Fax. 703-698-2733.

Extract

One of the most challenging applications of cardiopulmonary bypass is corrective cardiac surgery in the neonate. The small size and high metabolic demand of these patients require miniaturized but efficient equipment. Even with the most advanced components, the volume required to prime the perfusion circuit is typically more than twice the blood volume of a neonate. Neonates have limited cardiac and pulmonary reserves and, therefore, great care is required to preserve those organs that have often already been subjected to hypoxemia, congestive heart failure, or low cardiac output prior to surgery. There is a tendency toward extravascular movement of fluids in newborns subjected to bypass that can adversely affect outcome. Careful monitoring and precise management of perfusion are essential to a successful procedure and optimal recovery of these patients.

Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 2)
Copyright
Copyright © Cambridge University Press 1993

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References

1.Kirklin, JK. Neonatal cardiopulmonary bypass. In: Fetal and Neonatal Cardiology. Long, WA (ed). W. B. Saunders, Philadelphia, 1990, pp 736741.Google Scholar
2.Yeh, T Jr, Parmar, JM, Rebeyka, IM, Lofland, GK, Allen, L, Digman, RJ, Dyke, CM, Weschler, AS. Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecu lar weight hydroxyerhyl starch. J Thorac Cardiovasc Surg 1992; 104: 659665.Google Scholar
3.Marath, A, Man, W, Taylor, KM. Histamine release in paediatric cardiopulmonary bypass—a possible role in the capillary leak syndrome. Agents and Actions 1987; 20: 299302.CrossRefGoogle ScholarPubMed
4.Maehara, T, Novak, I, Elliott, MJ. Perioperative changes in total body water in children undergoing open heart surgery. Eur J Cardiothorac Surg 1991; 5: 258265.CrossRefGoogle ScholarPubMed
5.Castñeda, AR. Current trends in the management of infants with critical congenital heart defects. ProcArn Acad Cardiovasc Perfusion 1990; 11:6466.Google Scholar
6.Groom, RC, Hill, AG, Akl, BF, Lefrak, EA, Kurusz, M. Pediatric perfusion survey. Proc Am Acad Cardiovasc Perfusion 1990; 11:7885.Google Scholar
7.Norwood, W, Dobell, A, Freed, M, Kirklin, J, Blackstone, E. Intermediate results of the arterial switch repair. J Thorac Cardiovasc Surg 1988; 96: 854863.Google Scholar
8.Serraf, ABruniaux, J, Lacour-Gayett, F, Sidi, D, Kachaner, J, Bouchart, F, Planche, C. Anatomical correction of transposi tion of the great vessels. J Thorac Cardiovasc Surg 1991; 102: 140147.CrossRefGoogle Scholar
9.Castañeda, A, Norwood, W, Jonas, R, Colan, S, Sanders, S, Lang, P. Transposition of the great vessels and intact ventricular septum: Anatomical repair in the neonate. Ann Thorac Surg 1984; 38: 438443.Google Scholar
10.Atunes, M. Congenital heart disease in infancy: Surgery for specific defects. S Afr Med J 1885; 67: 363367.Google Scholar
11.Hill, AG, Groom, RC, Akl, BF, Lefrak, EA, Kurusz, M. 1990 Pediatric perfusion survey: Expanded multivariate analysis. Proc Am Acad Cardiovasc Perfusion 1991;12: 96103.Google Scholar
12.Hill, AG, Groom, RC, Akl, BF, Lefrak, EA, Kurusz, M. Pediatric perfusion. Current Prac North Am Perf 1993; 8: 2738.Google Scholar
13.Taylor, KM. Cardiopulmonary Bypass: Principles and Management. Taylor, KM (ed). Chapman and Hall Ltd., Cambridge, 1986. [preface]Google Scholar
14.Bellinger, DC, Wernovsky, G, Pappaport, LA, Mayer, JE, Castañeda, A, Hickey, PR, Jonas, RA, Newberger, JW. Cognitive development of children following early repair of transposition of the great vessels using deep hypothermia and circulatory arrest. Pediatrics 1991; 87: 701707.Google Scholar
15.Ferry, PC. Neurologic sequelae of open heart surgery in children. Am J Dis Child 1991; 144: 369373.Google Scholar
16.Glauser, TA, Ronke, LB, Weinberg, PM, Clancy, RR. Acquired neuropatholic lesions associated with hypoplastic left heart syndrome. Pediatrics 1990; 85: 9911000.CrossRefGoogle ScholarPubMed
17.Blackwood, M, Haka-Ikse, K, Steward, DJ. Developmental outcome in children undergoing surgery with profound hypo thermia. Anesthesiology 1986; 65: 437440.Google Scholar
18.Wells, FC, Coghill, , Caplan, HL. Duration of circulatory arrest does influence the psychological development of a child after cardiac operations early in life. J Thorac Cardiovasc Sung 1983; 86: 823831.Google Scholar
19.Jonas, RA. Myocardial protection or cerebral protection a potential conflict. J Thorac Cardiovas Surg 1992; 104:533534.Google Scholar
20.Wheeldon, DR, Bethune, DW, Gill, RD. Vortex pumping for routine cardiac surgery: a comparative study. Perfusion 1990; 135143.Google Scholar
21.Use of the constrained vortex pump in children under 20kg. Chui, BS, Shapiro, JH, Buckley, K, Allen, EL, Lofland, G. J Extracorporeal Tech 1992; 23: 98101.CrossRefGoogle Scholar
22.Williams, GD, Seifen, AB, Lawson, NW, Norton, JB, Readinger, RI, Dugan, TW, Callaway, JK. Pulsatile perfusion versus conventional high-flow perfusion for rapid core cooling and rewarming of infants for circulatory arrest in cardiac opera tions. J Thorac Cardiovasc Surg 1979; 78: 667677.CrossRefGoogle Scholar
23.Yasui, H, Yonenaga, K, Kado, H, Ando, H, Mizoguchi, Y, Honda, S, Tokunaga, K. Open-heart surgery in infants using pulsatile high flow cardiopulmonary bypass. J Cardiovas Surg 1989: 30: 661668.Google Scholar
24.Minami, K, Korner, MM, Vyska, K, Kleesiek, K, Knobl, H, Korner, R. Effects of pulsatile flow on plasma catecholamine levels and hemodynamics during and after cardiac surgery using cardiopulmonary bypass. J Thorac Cardiovasc Sung 1990; 99: 8291.Google Scholar
25.Levine, F, Philbin, DM, Kona, K, Coggins, CH, Emerson, CW, Austen, WG, Buckley, M. Plasma vasopressin levels and urinary sodium excretion during cardiopulmonary bypass with low flow. Ann Thorac Surg 1981; 32: 6467.Google Scholar
26.Taylor, KM, Wright, GS, Bain, GS, Caves, PK, Beastall, GS. Comparative studies of pulsatile flow during cardiopulmonary bypass II. J Thorac Cardiovasc Surg 1979; 34: 574578.Google Scholar
27.Taylor, KM, Wright, GS, Bain, GS, Caves, PK, Beastall, GS. Comparative studies of pulsatile flow during cardiopulmo nary bypass III. J Thorac Cardiovasc Sung 1979; 34: 579584.Google Scholar
28.Taylor, KM, Wright, GS, Bain, GS, Caves, PK, Beastall, GS. Comparative studies of pulsatile flow during cardiopulmo nary bypass I. J Thorac Cardiovasc Surg 1979; 34: 569574.Google Scholar
29.Taylor, KM. Pulsatile perfusion. In: Taylor, KM (ed). Cardiopulmonary Bypass: Principles and Management. Chapman and Hall Ltd, Cambridge, 1986, pp 85114.Google Scholar
30.Watanabe, T, Onita, H, Kobayashi, M, Washio, M. Brain tissue pH, oxygen tension, and carbon dioxide tension in profoundly hypothermic cardiopulmonary bypass. J Thorac Candiovasc Surg 1989; 97: 396401.Google Scholar
31.Wong, DY, Drumheller, EW, Anderson, RA, Motta, JG, Faro, RS. Pulsatile perfusion with a hollow fiber membrane oxygen ator. Proc Am Acad Cardiovasc Perfusion 1987; 8: 7073.Google Scholar
32.Lee, WH Jr, Krumhaar, D, Fonkalsrud, EW, Schjeide, OA, Maloney, JV Jr. Denaturation of plasma proteins as a cause of morbidity and death after intracardiac operations. Surgery 1961; 50: 2939.Google ScholarPubMed
33.Anderson, MN, Hambraeus, G. Physiologic and biochemical responses to extracorporeal circulation; Experimental studies during four hour perfusions. Ann Surg 1961; 153: 592598.Google Scholar
34.Hollenbeng, M, Pruetts, R, Thal, A. Vasoactive substances liberated by prolonged bubble oxygenation. J Thorac Cardiovasc Sung 1963; 45: 402411.Google Scholar
35.Hill, AG, Groom, RC, Smith, D, Speir, AM, Lefrak, EA. Complement activation during cardiopulmonary bypass: polyester versus nylon tricot in the oxygenator. Proc Am Acad Cardiovasc Perfusion 1984; 5: 1719.Google Scholar
36.Pearson, DT, Holden, MP, Waterhouse, PS, Ivor, JC. Gaseous microemboli during open heart surgery. Detection and pre vention. Proc Am Acad Cardiovasc Perfusion 1983; 4: 103109.Google Scholar
37.Hill, AG, Groom, R, Vinansky, RP, Speir, AM, Lefrak, EA. Gaseous microemboli and extracorporeal circulation. Proc Am Acad Cardiovasc Perfusion 1986; 7: 131137.Google Scholar
38.Allardyce, DB, Yoshida, SH, Ashmore, PG. The importance of microembolism in the pathogenesis of organ dysfunction caused by prolonged use of the pump oxygenator. J Thorac Cardiovasc Surg 1966; 52: 706715.CrossRefGoogle ScholarPubMed
39.Muraoka, R, Yokota, M, Aoshima, M, Kyoko, I, Nomoto, S, Kobayashi, A, Nakano, H, Ueda, K, Saito, A, Hojo, H. Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. J Thorac Cardiovasc Surg 1981; 81: 364369.CrossRefGoogle ScholarPubMed
40.Aberg, T, Ronquist, G, Tyden, H, Huitman, J, Bergstrom, K, Lilja, A. Adverse effects on the brain assessed by biochemical, psychometric, and radiologic methods. J Thorac Cardiovasc Surg 1984; 87: 99105.CrossRefGoogle ScholarPubMed
41.Hill, AG, Groom, RC, Vinansky, , Speir, AM, Macmanus, Q, Lefrak, EA. Hollow fiber membrane oxygenation and bubble oxygenation: a contrast. Proc Am Acad Cardiovasc Perfusion 1985; 6: 5158.Google Scholar
42.Clarke, RE, Beauchamp, RA, Magrath, RA, Brooks, JD, Weldon, CS. Comparison of bubble and membrane oxygenators in short and long perfusions. J Thorac Cardiovasc Surg 1979; 78: 655666.Google Scholar
43.Yeboah, ED, Petrie, A, Pead, JL. Acute renal failure and open heart surgery. Br MedJ 1972; 1: 415418.CrossRefGoogle ScholarPubMed
44.Dancy, CM, Townsend, ER, Boyett, A, Chan, SL, Parker-Williams, EJ, Parker, DJ. Pulmonary dysfunction asso ciated with cardiopulmonary bypass: A comparison of bubble and membrane oxygenators. Circulation 1981; 64M(suppl II): 11541157.Google Scholar
45.Alon, L, Turina, M, Isattiker, R. Membrane and bubble oxygen ator: A clinical comparison in patients undergoing aorto coronary bypass procedures. Herz 1979; 4: 5662.Google Scholar
46.Niguidula, FN, Romano, A, Eldredge, WJ. Clinical experience with membrane oxygenators on infants and children: Com parison with bubble oxygenator on 154 consecutive patients. Am J Cardiol 1977; 39: 261. [Abstract]Google Scholar
47.Hessel, EA, Johnson, DD, Ivey, TD, Miller, DW Jr. Membrane versus bubble oxygenators for cardiac operations: A prospec tive randomized study. Surgery 1980; 80: 111122.Google Scholar
48.Wright, JS, Fisk, GC, Torda, TA, Stacey, RB, Hicks, RG. Some advantages of membrane oxygenators for open heart surgery. J Thorac Cardiovasc Surg 1975; 69: 884890.Google Scholar
49.Orenstein, JM, Sato, N, Aron, B, Buchholz, B, Bloom, S. Microemboli observed in deaths following cardiopulmonary bypass. Human Pathol 1982; 13: 10821090.CrossRefGoogle ScholarPubMed
50.Videm, V.Fosse, E, Mollnes, TE, Karlsen, H, Pedersen, T, Garred, P. Complement activation induced by different tubings used for cardiopulmonary bypass. J Extra-Corporeal Technol 1989; 21: 2933.Google Scholar
51.Barry, YA, Labow, RS, Keon, WJ, Tocchi, M, Rock, G. Perioperative exposure to plasticizers in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 1989; 97: 900905.Google Scholar
52.Branger, B, Garreau, M, Baudin, G, Gris, JC. Biocomparibility of blood tubings. Int J Artif Organs 1990; 13: 697703.Google Scholar
53.Bretz, GE, Schermeyer, T, Donnelly, T. Long term tubing fatigue characteristics. J Extra-Corporeal Technol 1979; 11: 151156.Google Scholar
54.Charton, R. Tough tubing protects new blood supplement. Design News 1991; 5: 2.Google Scholar
55.Kessler, J, Patterson, RH Jr. The production ofmicroemboli by various blood oxygenators. Ann Thorac Surg 1970; 9:221228.Google Scholar
56.Hill, AG, Groom, RC, Kurusz, M, Conti, VR, Lefrak, EA. Arterial filtration: Heparin boned or unbonded—a compari son. Proc Am Acad Cardiovasc Perfusion 1985; 6: 132139.Google Scholar
57.Reed, CC, Romangoli, A, Taylor, DE, Clark, DK. Particulate matter in bubble oxygenators. J Thorac Cardiovasc Surg 1974; 68: 971974.Google Scholar
58.Yanez, NA, Reed, CC, Stafford, TB, Clay, C, Mclnnis, RJ. Pre-bypass filtration: A comparative investigation. Proc Am Acad Cardiovasc Perfusion 1982; 3: 2426.Google Scholar
59.Brooks, JD, Beauchamp, RA, Magrath, RA, Clark, RE. Efficacy of particulate removal by prebypass filters with different oxygenation systems. J Extra-Corporeal Technol 1979; 11: 175182.Google Scholar
60.Taylor, KM. Cardiopulmonary by pass. In: Taylor, KM (ed). Principles and Management. Chapman and Hall Ltd., Cambridge, 1986, p. 367.Google Scholar
61.Howard, E. Proc Am Acad Cardiovasc Perfusion 1992. [In press]Google Scholar
62.Naik, SK, Knight, A, Elliott, M. Prospective randomized study of a modified technique of ultrafiltration during pediatric open heart surgery. Circulation 1991; 84 (Suppl III): III 422III 431.Google ScholarPubMed
63.Kurusz, M, Conti, VR, Arens, JF, Brown, JV, Faulkner, SC, Manning, JV Jr. Perfusion accident survey. Proc Am Acad Cardiovasc Perfusion 1986; 7: 5765.Google Scholar
64.Kern, FH, Jonas, RA, Mayer, JE, Hanley, FL, Casrafleda, AR, Hickey, PR. Temperature monitoring during CPB in infants: Does it predict efficient brain cooling? Ann Thorac Surg 1992: 54: 749754.Google Scholar
65.Ratcliffe, JM, Wyse, RK, Hunter, S, Albertio, KG, Elliott, MJ. The role of priming fluid in the metabolic consequences to cardiopulmonary bypass. Thorac Cardiovsas Surgeon 1988; 36: 6574.Google Scholar
66.Ridley, PD, Ratcliffe, JM, Alberti, KG, Elliott, MJ. Metabolic consequences of a “washed” cardiopulmonary bypass pump prime fluid in children undergoing cardiac operations. J Thorac Cardiovasc Surg 1990; 100: 528–37.Google Scholar
67.Lonnquist, PA, Dobbs, J. Glucose, sodium, and plasma protein levels during deep hypothermic circulatory arrest using a low volume, minimal glucose priming solution based on washed packed red cells. Perfusion 1991; 6: 2330.Google Scholar
68.London, MJ, Franks, M, Verrier, ED, Merrick, SH, Levin, J, Mangano, DT. The safety and efficacy often percent pentastarch as a cardiopulmonary bypass prime. J Thorac Cardiovasc Surg 1992; 104: 284296.Google Scholar
69.Theunissen, F, Muylaert, P, Hermans, C, Goossens, G, Moeskops, J, Van Hoof, J, Alleman, J, Adriaensen, H, Priming solutions for cardiopulmonary bypass: comparison of three colloids. J Cardiothorac Vascu Anesth 1991; 5: 457466.Google Scholar
70.Halvorsen, L, Gunther, RA, Dubick, MA, Holcroft, JW. Dose response characteristics of hypertonic saline dextran solutions. J Trauma 1991; 32: 785794.Google Scholar
71.Manno, CS, Hegberg, KW, Kim, HC, Bunin, GR, Nicolsons, S, Jobes, D, Schwartz, E, Norwood, WJ. Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77: 930936.CrossRefGoogle ScholarPubMed
72.Kawamura, M, Minamikawa, O, Yokochi, H, Maki, S, Yasuda, T, Mizukawa, Y. Safe limit of hemodilution in cardiopulmo nary bypass: Comparative analysis between cyanotic and acyanotic congenital heart disease. Pediatr Cardiol 1991; 12: 170174.Google Scholar
73.Kirklin, JK. Neonatal Cardiopulmonary bypass. In: Fetal and Neonatal Cardiology. Long, WA (ed). W. B. Saunders, Philadelphia, 1990, p. 737.Google Scholar
74.Kawaguchi, A, Bergsland, J, Subramanian, S. Total bloodless open heart surgery in the pediatric age group. Circulation 1984; 70(Supp II); II 130II 137.Google Scholar
75.Henling, LC, Charmichael, MJ, Keats, AS, Cooley, DA. Cardiac operation for congenital heart disease in children ofJehovah's Witnesses. J Thorac Cardiovasc Surg 1985; 89: 914920.Google Scholar
76.Stein, JI, Gomboltz, H, Rigler, B, Metzler, H, Suppan, C, Beitzke, A. Open heart surgery in children of Jehovah's Witnesses: extreme hemodilution on cardiopulmonary bypass. Pediatr Cardiol 1991; 12: 170174.Google Scholar
77.Hill, AG, Groom, RC, Marino, JA, Munoz, R, McGowen, KJ, Devolder, R, Speir, AM, Lefrak, EA. More precise heparin and protamine management during cardiopulmonary by pass. Proc Am Acad Cardiovasc Perfusion 1990; 11; 1217.Google Scholar
78.Bull, BS, Huse, WM, Brauer, FS, Korpman, RA. Heparin therapy during extracorporeal circulation II. Use of a dose-response curve to individualize heparin and protamine dosage. J Thorac Cardiovasc Surg 1975; 69: 685689.Google Scholar
79.Reed, CR, Clark, DK. Cardiopulmonary Bypass. Texas Medi cal Press, Houston, 1975.Google Scholar
80.Kirklin, JK. Neonatal Cardiopulmonary bypass. In: Fetal and Neonatal Cardiology. Long, WA (ed). W.B. Saunders, Phila delphia, 1990, p. 736.Google Scholar
81.Galletti, PM, Brecher, GA. Heart-Lung Bypass, Principles and Techniques of Extracorporeal Circulation. Grune and Stratton, 1962, p. 252.Google Scholar
82.Stanley, TH, Iser-amaral, J. Mixed venous oxygen tension a simple metabolic monitor of the adequacy ofperfusion during cardiopulmonary bypass. Am Sect Proc, Volume 2, Dallas, 1974, pp 4144.Google Scholar
83.Croughwell, ND, Frasco, P, Blumenthal, JA, Leone, BJ, White, WD, Reves, JG. Warming during cardiopulmonary bypass is associated with jugular bulb desaturation. Ann Thorac Surg 1992; 53: 827832.Google Scholar
84.Wong, PC, Barlow, CF, Hickey, PR, Jonas, RA, Castañeda, AR, Farrell, DM, Lock, JE, Wessels, DL. Factors associated with choreathetosis after cardiopulmonary bypass in children with congenital heart disease. Circulation 1992; 86(Suppl II): II 118II 126.Google Scholar
85.Govier, AV, Reves, JG, McKay, RD, Karp, RB, Zorn, GL, Morawetz, RB, Smith, MA, Adams, Mary, Freeman, AM. Fac tors and their influence on regional cerebral blood flow during nonpulsatile cardiopulmonary by pass. Ann Thorac Surg 1984: 38: 592599.CrossRefGoogle Scholar
86.Prough, DS, Stump, DA, Roy, RC, Gravelee, G, Williams, T, Mills, SAHinshelwood, L, Howard, G. Response of cerebral blood flow to carbon dioxide tensions. Anesthesiology 1986: 64: 576581.Google Scholar
87.Kern, FH, Ungerleider, RM, Quill, TJ, Baldwin, B, White, WD, Reves, JG, Greeley, WJ. Cerebral blood flow response to changes in carbon dioxide tension during cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 1991; 101: 618622.Google Scholar
88.Venn, GE, Sherry, K, Newman, S, Harrison, M, Treasure, T. Cerebral blood flow determinants and their clinical implica tions during cardiopulmonary bypass. Perfusion 1988; 3: 271280.CrossRefGoogle Scholar
89.van der Linden, J, Wesslen, O, Ekroth, R, Tyden, H, von Ahn, H. Transcranial Doppler-estimated versus thermodilution-est imated cerebral blood flow during cardiac operations. J Thorac Cardiovasc Surg 1991; 102: 95102.Google Scholar
90.White, FN. A comparative physiological approach to hypo thermia. J Thorac Cardiovasc Surg 1981; 82: 821831.Google Scholar
91.Swan, JD, Smith, MW, Phelps, PC, Maki, A, Berezesky, IK, Trump, BF. Oxydative injury induces influx-dependent changes in intracellular calcium homeostasis. Toxicologic Path 1991; 19: 128137.Google Scholar
92.Abbott, A, Hill, R, Shears, L, Beamer, K, Gustafson, R. The effect of calcium on post ischemic isolated rat heart function. Ann Thorac Surg 1991; 51: 705710.Google Scholar
93.Caspi, J, Coles, JG, Benson, LN, Herman, SL, Augustine, J, Tsao, P.Brezina, A, Kolin, A, Wilson, GJ. Effects of high plasma epinephrine and Ca2+ concentrations on neonatal myocardial function after ischemia. J Thorac Cardiovasc Surg 1993; 105: 5967.Google Scholar
94.Chambers, DJ, Harvey, DM, Braimbridge, MV, Hearse, DJ. Transient hypocalcemic reperfusion does not improve postis chemic recovery in the rat heart after preservation with St. Thomas’ Hospital cardioplegic solution. J Thorac Cardiovasc Surg 1992; 104: 344–56.Google Scholar
95.Benzing, G, Francis, PD, Kaplan, S, Hellmsworth, JA, Sperling, MA. Glucose and insulin changes in infants and children undergoing hypothermic open-heart surgery. Am J Cardiol 1983; 52: 133136.CrossRefGoogle ScholarPubMed
96.Anderson, RV, Siegman, MG, Balaban, RS, Ceckler, TL, Swain, JA. Hyperglycemia increases cerebral intracellular acidosis during circulatory arrest. Ann Thorac Surg 1992; 54: 11261130.Google Scholar
97.Cohn, N. Anesthesia for neonatal cardiac surgery. In: Fetal and Neonatal Cardiology. Long, WA (ed). W.B. Saunders, Philadelphia, 1990, p. 725.Google Scholar
98.Murkin, JM, Farrar, JK, Tweed, A. Cerebral auto-regulation and flow/metabolism coupling during cardiopulmonary by pass. Anesth Analg 1987: 66: 825.Google Scholar
99.Sorensen, HR, Husum, B, Waaben, J. Brain microvascular function during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1987: 94: 727.Google Scholar
100.Ellis, RJ, Wisniewski, A, Potts, R. Reduction of flow rate and arterial pressure at moderate hypothermia does not result in cerebral dysfunction. J Thorac Cardiovasc Surg 1980: 79: 173177.Google Scholar
101.Hillier, SC, Burrows, FA, Bissonnette, B, Taylor, RH. Cerebral hemodynamics in neonates and infants undergoing cardiopul monary bypass and profound hypothermic circulatory arrest. Anesthes Analges 1991; 72: 723728.Google Scholar
102.Tranmer, BI, Gross, CE, Kindt, GW, Adey, GR. Pulsatile verses nonpulsatile flow in the treatment of acute cerebral ischemia. Neurosurgery 1986: 19: 724.Google Scholar
103.Anstadt, MP, Tedder, M, Hegde, SS, Khian Ha, VL, Perez-Tamayo, A, Abdel-aleem, S, Lowe, JE. Pulsatile versus nonpulsatile perfusion improves cerebral blood flow after cardiac arrest. Ann Thorac Surg [In press]Google Scholar
104.Hickey, PR, Anderson, NP. Deep hypothermia and circulatory arrest: A review of pathophysiological and clinical experience. J CardiothoracAnesthes 1987: 1: 137155.Google Scholar
105.Swain, JA, Robbins, RC, Balaban, R, McDonald, TJ, Schneider, B, Groom, RC. The effect of cardiopulmonary bypass on brain and heart metabolism. Mag Res Med 1990: 15: 446455.Google Scholar
106.Robbins, RC, Balaban, RS, Swain, J, McDonald, TJ, Schneider, B, Groom, RC. Intermittent hypothermic asanguinenous ce rebral perfusion. J Thorac Cardiovasc Surg 1990:99:878884.Google Scholar
107.Crittendon, MD, Roberts, CS, Rosa, L, Swain, JA, Balaban, R. Neurologic outcome after prolonged circulatory arrest. Ann Thorac Surg. [In press]Google Scholar
108.Swain, JA, McDonald, TJ, Griffith, PK, Balaban, RS, Clarke, RE, Ceckler, , Schneider, B, Beaney, M, Sellers, S. Low flow hypo thermic bypass protects the brain. J Thorac Cardiovasc Surg 1991: 102: 7684.CrossRefGoogle Scholar
109.Greeley, WJ, Kern, FH, Ungerleider, RM, Boyd, JL, Quill, T, Smith, RL, Baldwin, B, Reves, JG. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg 1991; 101: 783794.Google Scholar
110.MeConnell, JR, Fleming, WH, Wei-Kum, C, Hahn, FJ, Sariflan, LB, Hotchire, , Kugler, JD. Magnetic resonance imaging of the brain in infants and children before and after cardiac surgery. AmJ Dis Child 1990; 144: 374378.Google Scholar
111.Bilfinger, TV, Moeller, JT, Kurusz, M, Grimson, RC, Anangnostopoulos, CE. Pediatric myocardial protection in the United States: a survey of current clinical practice. Thorac Cardiovasc Surgeon 1992; 40: 214218.Google Scholar
112.Kirklin, JK, Kirklin, JW, and Pacifico, AD. Deep hypothermia and circulatory arrest. In: Arciniegas, E (ed). Pediatric Cardiac Surgery. Year Book Medical Publishers, Inc., Chicago, 1985.Google Scholar
113.Treasure, T, Naftel, DC, Conger, KA, Garcia, JH, Kirklin, JW, Blackstone, EH. The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry. J Thorac Cardiovasc Surg 1983; 86: 761770.Google Scholar
114.Mezrom, CK, Sadeghi, AM, Gandsas, A, Shiang, HH, Levy, D, Green, R, Holzman, IR, Greipp, R. Cerebral blood flow and metabolism in hypothermic circulatory arrest. Ann Thorac Surg 1992: 54: 609616.CrossRefGoogle Scholar
115.Pollard, HS, Feischaker, RJ, Timmes, JJ, Karlson, KE. Blood brain barrier studies in extracorporeal cooling and warming. J Thorac Cardiovasc Surg 1961: 42: 772778.Google Scholar
116.Butler, BD, Kurusz, M. Gaseous microemboli: a review. Perfusion 1990; 5: 8199.Google Scholar
117.Donald, DE, Fellows, JL. Relation of temperature, gas tension, and hydrostatic pressure to the formation of gas bubbles in extracorporeal oxygenated blood. Surg Forum 1959; 10:589592.Google Scholar
118.Hill, AG, Groom, RC, Vinansky, RV, Speir, AM, Macmanus, Q, Lefrak, EA. Gaseous microemboli and extracorporeal circulation. Proc Am Acad Cardiovasc Perfusion 1986; 7: 131136.Google Scholar
119.Barratt-Boyes, BG. Choreathetosis a complication ofcardiopul monary bypass. Ann Thorac Surg 1990: 50: 693694.Google Scholar
120.Rebeyka, IM, Hanan, SA, Borges, MR, Lee, KF, Williams, WG, Weschler, AS. Rapid cooling contracture of the myocardium. J Thorac Cardiovasc Surg 1990; 100: 240249.Google Scholar
121.Fox, L, Blackstone, EH, Kirklin, JW, Bishop, SP, Bergdahl, AL, Bradley, EL. Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypo thermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1984: 87: 658664.Google Scholar
122.Mavroudis, C, Brown, GL, Katzmark, SL, Howe, WR, Laman, GABlood flow distribution in infant pigs subjected to surface cooling, deep hypothermia, and circulatory arrest. J Thorac Cardiovasc Surg 1984: 87: 665672.Google Scholar
123.Drinkwater, DC, Laks, H. Cardioplegia for pediatric open-heart surgery. In: Engleman, RM, Levitsky, S (eds). A Textbook of Cardioplegia for Difficult Clinical Problems. Futura Publishing, New York, 1992, pp 319328.Google Scholar
124.Stein, DG, Laks, H, Drinkwater, DC. Myocardial protection in children. In: Karp, RB, Laks, H, Wechsler, AS (eds). Advances in Cardiac Surgery. Mosby Year Book, St. Louis, 1992, pp 113133.Google Scholar
125.Magovern, JA, Pae, WE, Waidhausen, JA. Myocardial preservation in infants and children. In: Waidhausen, JA, Orringer, MB, (eds). Complications in Cardiothoracic Surgery. Mosby Year Book, St. Louis, 1991, pp 8290.Google Scholar
126.Wilson, IC, DiNatale, JM, Gillinov, AM, Curtis, WE, Cameron, DE, Gardner, TJ. Leukocyte depletion in a neonatal model of cardiac surgery. Ann Thorac Surg 1993; 55: 1219.Google Scholar
127.del Nido, PJ, Swan, PR, Benson, LN, Bohn, D, Charlton, MC, Coles, JG, Trusler, GA, Williams, WG. Successful use of intraaortic balloon pumping in a 2-kilogram infant. Ann Thorac Surg 1988; 46: 574576.Google Scholar
128.Karl, TR, Sano, S, Horton, S, Mee, RBB. Centrifugal pump left heart assist in pediatric cardiac operations. J Thorac Cardiovasc Surg 1991; 102: 624630.Google Scholar
129.Pennington, DG, Swartz, MT. Circulatory support in infants and children. Ann Thorac Surg 1993; 55: 233237.Google Scholar