Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-20T01:31:55.867Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical palliation of hypoplastic left heart syndrome: is there a role for hypothermic circulatory arrest?

Published online by Cambridge University Press:  21 September 2005

Marshall L. Jacobs
Marshall L. Jacobs
Affiliation:
Department of Cardiothoracic Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, USA
Get access Rights & Permissions [Opens in a new window]

Extract

The technique of deep hypothermia with circulatory arrest has been important in the history of the evolution of cardiac surgery. Wilfred G. Bigelow, working in Toronto in the late 1940s, performed pioneering research on hypothermia, and developed a workable technique of hypothermia in human cardiac surgery.1 Based upon Bigelow's experimental premises, F. John Lewis, at the University of Minnesota, also conducted a number of experiments utilizing hypothermia. On September 2, 1942, Lewis operated on a 5-year-old girl with an atrial septal defect under general hypothermia with inflow occlusion. He was assisted by Richard Varco, Mansur Taufic, and C. Walton Lillehei. Rubberized refrigerated blankets were used to cool the patient to 28°C. The septal defect was closed during five and a half minutes of inflow occlusion. This was the world's first successful open operation on the human heart performed under direct vision, and marked the beginning of the era of open heart surgery. Now, as amazing and as primitive as that methodology may seem, those of you who read Life magazine, or watch the Discovery Channel on television, are aware that, in parts of the Soviet Union, a large fraction of today's open heart surgery is performed not using the technique of cardiopulmonary bypass, but rather using the methodology of immersion hypothermia from the 1950s, with surprisingly good results.

Type
Norwood Procedure and Staged Palliation
Information
Cardiology in the Young , Volume 14 , Issue S1 , February 2004 , pp. 65 - 69
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bigelow WG, Lindsay WK, Greenwood WF. Hypothermia – its possible role in cardiac surgery: An investigation of factors governing survival in dogs at low body temperatures. Ann Surg 1950; 132: 849–864.Google Scholar
Horiuchi T, Koyama K, Matano I, et al. Radical operation for ventricular septal defects in infancy. J Thorac Cardiovasc Surg 1963; 46: 180–184.Google Scholar
Barratt-Boyes BG, Simpson MM, Neutz JM. Intracardiac surgery in neonates and infants using deep hypothermia. Circulation 1970; 61, 62 (Suppl III): III-73.Google Scholar
Newburger JW, Jonas RA, Wernovsky G, et al. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 1993; 329: 1057–1064.Google Scholar
Skaryak LA, Lodge AJ, Kirshbom PM, DiBernardo LR, Wilson BG, Meliones JN, Ungerleider RM, Gaynor JW. Low-flow cardiopulmonary bypass produces greater pulmonary dysfunction than circulatory arrest. Ann Thorac Surg 1996; 62: 1284–1288.Google Scholar
Scheller MS, Brandon PJ, Cornacchia LG, Alksne JF. A comparison of the effects on neuronal Golgi morphology assessed with electron microscopy of cardiopulmonary bypass, low-flow bypass, and circulatory arrest during profound hypothermia. J Thorac Cardiovasc Surg 1992; 104: 1395–1404.Google Scholar
Jonas RA. Deep hypothermic circulatory arrest: Current status and indications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 76–88.Google Scholar
Jonas RA, Bellinger DC, Rappaport LA, et al. Relation of pH strategy and developmental outcome after hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1993; 106: 362–368.Google Scholar
Shin'oka T, Shum-Tim D, Jonas RA, et al. Higher hematocrit improves cerebral outcome after deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1996; 112: 1610–1621.Google Scholar
Clancy RR, McGaurn SA, Goin JE, Hirtz DG, Norwood WI, Gaynor JW, Jacobs ML, Wernovsky G, Mahle WT, Murphy JD, Nicolson SC, Steven JM, Spray TL. Allopurinol neurocardiac progestion trial in infants undergoing heart surgery using deep hypothermic circulatory arrest. Pediatrics 2001; 108: 61–70.Google Scholar
Nollert G, Nagashima M, Bucerius J, et al. Oxygenation strategy and neurological damage after deep hypothermic circulatory arrest. II. Hypoxic versus free radical injury. J Thorac Cardiovasc Surg 1999; 117: 1172–1179.Google Scholar
Shum-Tim D, Nagashima M, Shin'oka T, Bucerius J, Nollert G, Lidov HG, du Plessis A, Laussen PC, Jonas RA. Postischemic hypothermia exacerbates neurologic injury after deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1988; 116: 780–792.Google Scholar
Asou T. Arch reconstruction without circulatory arrest: Historical perspective and initial clinical results. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 89–94.Google Scholar
Pigula FA. Arch reconstruction without circulatory arrest: Scientific basis for continued use and application to patients with arch anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 104–115.Google Scholar
Hoffman GM, Stuth EA, Jaquiss RD, Staudt SR, Troshynski TJ, Vanderwal PK, Tweddell JS. Cerebral oxygenation decreases, and somatic oxygenation increases, following cardiopulmonary bypass with continuous cerebral perfusion for stage I palliation of hypoplastic left heart syndrome. Abstract, Proceedings of the 83rd Annual Meeting of the Am Assoc for Thorac Surg, Boston, Mass., May 4–7, 2003.