A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients

Background: The objective of this randomized clinical trial was to investigate the effects of perfusion modalities on cerebral hemodynamics, vital organ injury, quantified by the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) Score, and clinical outcomes in risk-stratified congenital cardiac surgery patients. Methods: This randomized clinical trial included 159 consecutive congenital cardiac surgery patients in whom pulsatile (n = 83) or nonpulsatile (n = 76) perfusion was used. Cerebral hemodynamics were assessed using transcranial Doppler ultrasound. Multiple organ injury was quantified using the PELOD-2 score at 24, 48, and 72 hours. Clinical outcomes, including intubation time, intensive care unit length of stay (LOS), hospital LOS, and mortality, were also evaluated. Results: The Pulsatility Index at the middle cerebral artery and in the arterial line during aortic cross-clamping was consistently better maintained in the pulsatile group. Demographics and cardiopulmonary bypass characteristics were similar between the 2 groups. While risk stratification with The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Categories was similar between the groups, Mortality Categories 1 to 3 demonstrated more patients than Mortality Categories 4 and 5. There were no differences in clinical outcomes between the groups. The PELOD-2 scores showed a progressive improvement from 24 hours to 72 hours, but the results were not statistically different between the groups. Conclusions: The Pulsatillity Index for the pulsatile group demonstrated a more physiologic pattern compared with the nonpulsatile group. While pulsatile perfusion did not increase plasma-free hemoglobin levels or microemboli delivery, it also did not demonstrate any improvements in clinical outcomes or PELOD-2 scores, suggesting that while pulsatile perfusion is a safe method, it not a “magic bullet” for congenital cardiac operations.

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Work Title A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients
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Open Access
Creators
  1. Akif Ündar
  2. Krishna Patel
  3. Ryan M. Holcomb
  4. Joseph B. Clark
  5. Gary D. Ceneviva
  6. Christine A. Young
  7. Debra Spear
  8. Allen R. Kunselman
  9. Neal J. Thomas
  10. John L. Myers
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Annals of Thoracic Surgery
Publication Date October 1, 2022
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.athoracsur.2022.02.053
Deposited August 05, 2024

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Version 1
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  • Created
  • Added 2022-ATS-Perfusion_Modalities-Undar.pdf
  • Added Creator Akif Ündar
  • Added Creator Krishna Patel
  • Added Creator Ryan M. Holcomb
  • Added Creator Joseph B. Clark
  • Added Creator Gary D. Ceneviva
  • Added Creator Christine A. Young
  • Added Creator Debra Spear
  • Added Creator Allen R. Kunselman
  • Added Creator Neal J. Thomas
  • Added Creator John L. Myers
  • Published
  • Updated