Research Article| Volume 16, ISSUE 1, P59-61, 2013

Download started.


Neonatal Cardiopulmonary Bypass

  • Philippe Pouard
    Address reprint requests to P. Pouard, MD, Hôpital Necker-Enfants Malades, Université Paris V, 149 rue de Sèvres, 75015, Paris, France
    Departments of Anaesthesiology, Intensive Care, and Congenital Cardiac Surgery, Hôpital Necker-Enfants Malades, Université Paris V, Paris, France
    Search for articles by this author
  • Mirela Bojan
    Departments of Anaesthesiology, Intensive Care, and Congenital Cardiac Surgery, Hôpital Necker-Enfants Malades, Université Paris V, Paris, France
    Search for articles by this author
      Cardiac surgery with cardiopulmonary bypass is routinely used in neonates who require early repair of congenital heart diseases. However, the bypass temperature and use of deep hypothermic circulatory arrest, the composition of the priming and the acceptable degree of hemodilution, the prophylactic use of antifibrinolytic agents and steroids, the choice of myocardial protection, the best PaO2, and even the pump flow, are still subjects of debate, despite major improvements in neonatal bypass over the last decade. Nevertheless, there are some techniques that have reached a near-consensus and are highly recommended in neonates: the use of minaturized bypass circuits to reduce blood product transfusions and inflammation, ultrafiltration, and the continuous monitoring of mixed venous and regional oxygen saturations to assess adequacy of perfusion. Nevertheless, surprisingly many different techniques may lead to the same results and mortality rate. As operative mortality rates have declined, the comparison endpoints between techniques have moved and focus on morbidity rates, extubation delay, ICU and hospital length of stay; in other words, the cost and (of course) the late functional outcome are certainly the new goals of neonatal cardiopulmonary bypass.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Ly M.
        • Roubertie F.
        • Belli E.
        • et al.
        Continuous cerebral perfusion for aortic arch repair: hypothermia versus normothermia.
        Ann Thorac Surg. 2011; 92: 942-948
        • Pouard P.
        • Mauriat P.
        • Ek F.
        • et al.
        Normothermic cardiopulmonary bypass and myocardial cardioplegic protection for neonatal arterial switch operation.
        Eur J Cardiothorac Surg. 2006; 30: 695-699
        • Bellinger D.C.
        Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass.
        Circulation. 1999; 100: 526-532
        • Hovels-Gurich H.H.
        Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation.
        J Thorac Cardiovasc Surg. 2002; 124: 448-458
        • Fuller S.
        • Nord A.S.
        • Gerdes M.
        • et al.
        Predictors of impaired neurodevelopmental outcomes at one year of age after infant cardiac surgery.
        Eur J Cardiothorac Surg. 2009; 36: 40-47
        • Andropoulos D.B.
        • Hunter J.V.
        • Nelson D.P.
        • et al.
        Brain immaturity is associated with brain injury before and after neonatal cardiac surgery with high-flow bypass and cerebral oxygenation monitoring.
        J Thorac Cardiovasc Surg. 2010; 139: 543-556
        • Loeffelbein F.
        • Zirell U.
        • Benk C.
        • et al.
        High colloid oncotic pressure priming of cardiopulmonary bypass in neonates and infants: implications on haemofiltration, weight gain and renal function.
        Eur J Cardiothorac Surg. 2008; 34: 648-652
        • Riegger L.Q.
        • Voepel-Lewis T.
        • Kulik T.J.
        • et al.
        Albumin versus crystalloid prime solution for cardiopulmonary bypass in young children.
        Crit Care Med. 2002; 30: 2649-2654
        • Oliver Jr, W.C.
        • Beynen F.M.
        • Nuttall G.A.
        • et al.
        Blood loss in infants and children for open heart operations: albumin 5% versus fresh-frozen plasma in the prime.
        Ann Thorac Surg. 2003; 75: 1506-1512
        • Kalavrouziotis D.
        • Voisine P.
        • Mohammadi S.
        • et al.
        High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass.
        Ann Thorac Surg. 2012; 93: 148-154
        • Robertson-Malt S.
        • Afrane B.
        • El Barbary M.
        Prophylactic steroids for pediatric open heart surgery.
        Cochrane Database Syst Rev. 2007; (CD005550)
        • Graham E.M.
        • Atz A.M.
        • Butts R.J.
        • et al.
        Standardized preoperative corticosteroid treatment in neonates undergoing cardiac surgery: results from a randomized trial.
        J Thorac Cardiovasc Surg. 2011; 142: 1523-1529
        • Kronon M.
        • Bolling K.S.
        • Allen B.S.
        • et al.
        The importance of cardioplegic infusion pressure in neonatal myocardial protection.
        Ann Thorac Surg. 1998; 66: 1358-1364
        • Caputo M.
        • Mokhtari A.
        • Rogers C.A.
        • et al.
        The effects of normoxic versus hyperoxic cardiopulmonary bypass on oxidative stress and inflammatory response in cyanotic pediatric patients undergoing open cardiac surgery: a randomized controlled trial.
        J Thorac Cardiovasc Surg. 2009; 138: 206-214
        • Prabhune A.
        • Sehic A.
        • Spence P.A.
        • et al.
        Cerebral oximetry provides early warning of oxygen delivery failure during cardiopulmonary bypass.
        J Cardiothorac Vasc Anesth. 2002; 16: 204-206
        • Kussman B.D.
        • Wypij D.
        • Laussen P.C.
        Relationship of intraoperative cerebral oxygen saturation to neurodevelopmental outcome and brain magnetic resonance imaging at 1 year of age in infants undergoing biventricular repair.
        Circulation. 2010; 122: 245-254
        • Ghanayem N.S.
        • Wernovsky G.
        • Hoffman G.M.
        Near-infrared spectroscopy as a hemodynamic monitor in critical illness.
        Pediatr Crit Care Med. 2011; 12: 27-32
        • Kasman N.
        • Brady K.
        Cerebral oximetry for pediatric anesthesia: why do intelligent clinicians disagree?.
        Paediatr Anaesth. 2011; 21: 473-478