Abstract
Purpose
Postoperative inflammatory response and perioperative systemic edema are the risks of failed Fontan circulation. We evaluated the efficiency of the miniaturized, poly-2-methoxyethylacrylate (PMEA)-coated cardiopulmonary bypass (CPB) circuit, which we devised in 2003, in the Fontan circulation.
Methods
Thirty-seven patients who underwent the Fontan procedure between March 1996 and December 2006 were divided into two groups: one consisting of patients with a priming-volume >250 m on uncoated conventional bypass (group C; n = 20), and one consisting of those with miniaturized (<200 ml) and PMEA-coated circuits (group M; n = 17). We compared the body weight gain (%BWG), minimum platelet count, maximum postoperative C-reactive protein (CRP), and minimum hematocrit (Hct) levels during the operation, maximum white blood cell (WBC) count, and postoperative pleural effusion, between the two groups. Stepwise multiple logistic regression analyses were used to investigate the most affecting factors.
Results
The %BWG and CRP levels were significantly lower in group M (P = 0.047 and P = 0.012, respectively). The minimum platelet count was significantly higher in group M (P = 0.012). There were no significant differences in postoperative pleural effusion, minimum Hct, or maximum WBC.
Conclusion
The miniaturized biocompatible CPB system reduced perioperative inflammatory responses.
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References
Miyaji K, Miyamoto T, Kohira S, Nakashima K, Inoue N, Sato H, et al. Miniaturized cardiopulmonary bypass system in neonates and small infants. Interact Cardiovasc Thorac Surg 2008;7:75–79.
Miyaji K, Kohira S, Miyamoto T, Nakashima K, Sato H, Ohara K, et al. Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg 2007;134:284–289.
Ninomiya M, Miyaji K, Takamoto S. Influence of PMEA-coated bypass circuits on perioperative inflammatory response. Ann Thorac Surg 2003;75:913–918.
Gaynor JW, Bridges ND, Cohen MI, Mahle WT, Decampli WM, Steven JM, et al. Predictors of outcome after the Fontan operation: is hypoplastic left heart syndrome still a risk factor? J Thorac Cardiovasc Surg 2002;123:237–245.
Burkhart HM, Dearani JA, Williams WG, Puga FJ, Mair DD, Ashburn DA, et al. The modified Fontan procedure: early and late results in 132 adult patients. J Thorac Cardiovasc Surg 2003;125:1252–1259.
Ikuta T, Fujii H, Shibata T, Hattori K, Hirai H, Kumano H, et al. A new poly-2-methoxyethylacrylate-coated cardiopulmonary bypass circuit possesses superior platelet preservation and inflammatory suppression efficacy. Ann Thorac Surg 2004;77:1678–1683.
Kutay V, Noyan T, Ozcan S, Melek Y, Ekim H, Yakut C. Biocompatibility of heparin-coated cardiopulmonary bypass circuit in coronary patients with left ventricular dysfunction is superior to PMEA-coated circuits. J Card Surg 2006;21:572–577.
Huebler M, Boettcher W, Koster A, Emeis M, Lange P, Hetzer R. Transfusion-free complex cardiac surgery with cardiopulmonary bypass in a 3.55-kg Jehovah’s Witness neonate. Ann Thorac Surg 2005;80:1504–1506.
Beghi C, Nicolini F, Agostinelli A, Borrello B, Budillon AM, Bacciottini F, et al. Mini-cardiopulmonary bypass system: results of a prospective randomized study. Ann Thorac Surg 2006;81:1396–1400.
Abdel-Rahman U, Ozaslan F, Risteski PS, Martens S, Moritz A, Al Daraghmeh A, et al. Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit? Ann Thorac Surg 2005;80:238–243.
Fromes Y, Gaillard D, Ponzio O, Chauffert M, Gerhardt MF, Deleuze P, et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg 2002;22:527–533.
Remadi JP, Marticho P, Butoi I, Rakotoarivelo Z, Trojette F, Benamar A, et al. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg 2004;77:2172–2176.
Shiraishi S, Uemura H, Kagisaki K, Koh M, Yagihara T, Kitamura S. The off-pump Fontan procedure by simply cross-clamping the inferior caval vein. Ann Thorac Surg 2005;79:2083–2088.
Kawahira Y, Uemura H, Yagihara T. Impact of the off-pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg 2006;81:685–689.
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Itatani, K., Miyaji, K., Miyamoto, T. et al. Miniaturized biocompatible cardiopulmonary bypass for the Fontan procedure. Surg Today 40, 1040–1045 (2010). https://doi.org/10.1007/s00595-009-4178-3
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DOI: https://doi.org/10.1007/s00595-009-4178-3