TITLE

Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt

AUTHOR(S)

Tireli, Emin; Basaran, Murat; Kafali, Eylul; Harmandar, Bugra; Camci, Emre; Dayioglu, Enver; Onursal, Ertan

PUB. DATE

April 2003

SOURCE

European Journal of Cardio-Thoracic Surgery;Apr2003, Vol. 23 Issue 4, p518

SOURCE TYPE

Academic Journal

DOC. TYPE

Article

ABSTRACT

Objective: In patients with functional single ventricular physiology, the avoidance of cardiopulmonary bypass offers many advantages including earlier extubation, decreased necessity of inotropic support, improved hemodynamical status and reduced likehood of post-operative prolonged pleural effusion. We believe that the bidirectional cavopulmonary anastomosis operations may be performed with transient external shunt techniques. The purpose of this prospective study is the peri- and post-operative comparison of different transient external shunt methods used in bidirectional cavopulmonary shunt operations. Methods: Between years 1997 and 2000, 30 patients have undergone bidirectional cavo-pulmonary shunt operation by using three different types of external shunt. The mean patient age was 13 months (range, 3 months–3 years). Previous operations had been performed in ten patients (33%). All patients were divided into three groups according to type of external shunt used. In group A (ten patients), the transient external shunt was constructed between superior vena cava and right atrium by uniting two standard venous cannulas with a Y-connector. In group B (ten patients), the external shunt was performed with a single short venous cannula constructed between superior vena cava and right atrium. In group C (ten patients), the external shunt was constructed between superior vena cava and left pulmonary artery by using a single short venous cannula. During operation, central venous pressure (CVP), arterial O2 saturation and mean arterial blood pressure were recorded continuously. Results: All operations are completed without the establishment of cardiopulmonary bypass. Hospital mortality was 3.3%. One patient in group A died because of low cardiac output at the end of postoperative day 2. All patients were extubated within 4 h. In groups A–C mean superior vena caval pressures were measured 28, 24 and 21 mmHg, respectively during superior vena cava-right pulmonary artery anastomosis. In both groups A and B patients, arterial O2 saturation decreased to a minimum 53±2 and 53±2%, respectively during the operation. In the group C, minimum arterial O2 saturation was measured 82±2%. Although mean arterial pressure decreased in all groups during clampage; in group C patients, this drop is not significant. Conclusion: Based on the study presented here, bidirectional cavo-pulmonary anastomosis can be carried out by using different types of transient external shunt. The best hemodynamical condition and arterial O2 levels were achieved with the shunt constructed between superior vena cava and left pulmonary artery.

ACCESSION #

9500052

 

Related Articles

• Management of the Elderly Cardiac Surgical Patient: Neurological Sequelae. Infeld, Bernard // Heart, Lung & Circulation;Sep2004 Supplement 3, Vol. 13, pS19 

  The main neurological complications after cardiac surgery and non-surgical cardiac procedures include stroke, encephalopathy and neuropsychological deficits. Embolism from aortic atherosclerosis is the most common pathogenic mechanism. This article reviews the incidence, risk factors, and...

• Aldo R. Castañeda. Vida, Vladimiro L.; Sade, Robert M.; Stellin, Giovanni // Cardiology in the Young;Jun2006, Vol. 16 Issue 3, p221 

  The article profiles cardiac surgeon Aldo R. Castañeda in Central America. He was born in Nervi, close to Genoa, Italy on July 17, 1930. He made remarkable contributions to pediatric cardiac surgery and created over 400 scientific articles and two books. In addition, he was also devoted to a...

• Cardiac surgery with cardiopulmonary bypass: does aprotinin affect outcome? P. J. Van der Linden; J.-F. Hardy; A. Daper; A. Trenchant; S. G. De Hert // BJA: The British Journal of Anaesthesia;Oct2007, Vol. 99 Issue 5, p646 

  Background Aprotinin, a non-specific serine protease inhibitor, has been used for two decades to reduce perioperative blood loss and the risk for allogeneic transfusion in cardiac surgery. This study evaluated the effects of aprotinin on outcome (mortality, cardiac events, renal failure, and...

• Massive Intravascular Thrombosis and Thromboembolism after Cardiopulmonary Bypass. Ramsey, Michael A. E.; Marcel, Randy J.; Capeheart, John; Cheung, Edson H.; Ring, W. Steves // Internet Journal of Thoracic & Cardiovascular Surgery;2002, Vol. 5 Issue 2, p83 

  This report describes two patients who underwent cardiac surgery utilizing cardiopulmonary bypass (CPB). Both patients were fully heparinized during the bypass period; however, both of them developed massive intravascular thrombosis and thromboembolism after initiation of heparin reversal with...

• QTc prolongation in children following congenital cardiac disease surgery. Punn, Rajesh; Lamberti, John J.; Balise, Raymond R.; Seslar, Stephen P. // Cardiology in the Young;Aug2011, Vol. 21 Issue 4, p400 

  IntroductionQTc prolongation has been reported in adults following cardiopulmonary bypass; however, this phenomenon has not been studied in children with congenital cardiac disease. This study's aim was to formally assess QTc in children undergoing cardiac surgery.MethodsPre-operative and...

• Cardiomyocyte apoptosis and duration of aortic clamping in pig model of open heart surgery Malmberg, Markus; Vähäsilta, Tommi; Saraste, Antti; Kytö, Ville; Kiss, Jan; Kentala, Erkki; Kallajoki, Markku; Savunen, Timo // European Journal of Cardio-Thoracic Surgery;Sep2006, Vol. 30 Issue 3, p480 

  Abstract: Objective: Apoptotic cardiomyocyte death is induced during open heart surgery, but its determinants are poorly understood. Prolonged aortic clamping time is associated with adverse clinical outcomes. The purpose of this study was to determine whether occurrence of cardiomyocyte...

• Antioxidant defence during cardiopulmonary bypass surgery Luyten, Chris R.; van Overveld, Frans J.; De Backer, Lieve A.; Sadowska, Anna M.; Rodrigus, Inez E.; De Hert, Stefan G.; De Backer, Wilfried A. // European Journal of Cardio-Thoracic Surgery;Apr2005, Vol. 27 Issue 4, p611 

  Abstract: Objective: Cardiac surgery may lead to severe oxidative stress due to formation of oxidation products generated during ischemia and reperfusion. We investigated to which extent oxidative stress influences a number of endogenous antioxidants and markers of cellular activation. Methods:...

• Radical resection of a pulmonary blastoma involving the pulmonary artery. He, Wenxin; Jiang, Gening; Xie, Boxiong; Liu, Ming // European Journal of Cardio-Thoracic Surgery;Sep2008, Vol. 34 Issue 3, p695 

  Abstract: Pulmonary blastoma is a rare malignant lesion with a poor prognosis. We described a case of a 47-year-old woman with a large biphasic pulmonary blastoma, involving the left pulmonary artery. Under cardiopulmonary bypass, it was treated with radical left intrapericardial pneumonectomy...

• Alteration of vancomycin pharmacokinetics during cardiopulmonary bypass in patients undergoing cardiac surgery. Garcia, Maria Pilar Ortega; Marti-Bonmati, Ezequiel; Serrano, Javier Guevara; Gomez, Isabel Gil // American Journal of Health-System Pharmacy;2/15/2003, Vol. 60 Issue 4, p260 

  Studies the alteration of vancomycin pharmacokinetics during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery. Patient characteristics; Vancomycin pharmacokinetic values; Serum vancomycin concentrations of patients; Biochemical and pharmacokinetic values before, during and...

Read the Article