TY - JOUR
T1 - A Randomized Clinical Trial of Perfusion Modalities in Pediatric Congenital Heart Surgery Patients
AU - Ündar, Akif
AU - Patel, Krishna
AU - Holcomb, Ryan M.
AU - Clark, Joseph B.
AU - Ceneviva, Gary D.
AU - Young, Christine A.
AU - Spear, Debra
AU - Kunselman, Allen R.
AU - Thomas, Neal J.
AU - Myers, John L.
N1 - Funding Information:
Funding for this work was provided by multiple seed funds from the Pediatric Cardiovascular Research Center at the Penn State Health Children’s Hospital and Penn State College of Medicine . The authors wish to acknowledge and thank the following individuals: neuromonitoring technicians, perfusionists, operating room nurses, and pediatric intensive care unit nurses. They especially thank Jennifer Stokes, RN, MSN, and her team in the Pediatric Clinical Research Office within the Penn State Health Children’s Hospital.
Publisher Copyright:
© 2022 The Society of Thoracic Surgeons
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85127458383&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127458383&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2022.02.053
DO - 10.1016/j.athoracsur.2022.02.053
M3 - Article
C2 - 35292258
AN - SCOPUS:85127458383
SN - 0003-4975
VL - 114
SP - 1404
EP - 1411
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -