Experiences of cardiopulmonary bypass for children heart transplantation
Li Ping
Zhao Yang
Dong Nian-guo
Gao Si-hai
Abstract：Objective To summarize the experiences of cardiopulmonary bypass (CPB) in 20cases of pediatric heart trans?plantation. Methods Twentycases of pediatric heart transplantation were performed in wuhan Union hospital from September 2008 to March 2015,including 11 male and 9 female.The main cause of transplantation was dilated cardiomyopathy. The average age was 10.76 ±5.97 years old with the minimum age of 3 months.The average weight was 33.23±18.51 kg, the minimum body weight being 5.2 kg. Cardioplegia of Histidin-Tryptophan-Ketoglutarat ( HTK) was delivered for the protection of the donor hearts. The removed hearts were infused with and stored in 4℃ HTK solution. Donor/recipient body weight ratio was 1.62±0.62. Mild hypothermia,moderate hemodilu?tion and high flow rate perfusion were used during CPB. Blood gas and electrolyte were monitored continuously,and the application of ul?trafiltration and albumin before termination of bypass were essential tomaintain a MAP of 55 to 65 mm Hg, SvO2>70%, Hct 0.24-0.27 during the CPB, and Hct 0.32-0.40 after modified ultrafiltration. Results Except 2 cases of heart transplantation were supported by ECMO due to postoperative low cardiac output, 18 cases achieved rebeatingautomatically, and successfully weaned from cardiopulmo?nary bypass. All patients obtainedsatisfactory curative effect. The CPB time was 119.56±42.32min, and cold ischemia time was 228.69 ±144.97 min,andparallel bypass time was 72.25±35.78 min. Conclusion Effective myocardial protection to the donor heart,effective colloid osmotic pressure maintainance and application of ultrafiltration and albumin are essential to guarantee the success of CPB man?agement. The use of ECMO as a timely manner for patients who cannot wean from CPB during operation or with postoperative low cardi?ac output can effectively improve the success rate of pediatric orthotopic heart transplantation.
Keywords：ChildHeart transplantationCardiopulmonary bypass
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 219-222 )