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Ann Thorac Surg 1995;59:384-388
© 1995 The Society of Thoracic Surgeons
The Albert Starr Academic Center for Cardiac Surgery, St. Vincent Hospital and Medical Center, and Emanuel Hospital, Portland, Oregon
Accepted for publication September 20, 1994.
Eleven infants and children with a body weight of less than 10 kg (median weight, 6.8 kg) whose parents were Jehovah's Witnesses underwent repair (n = 10) or palliation (n = 1) of congenital heart defects without the use of blood products and with (n = 9) or without (n = 2) cardiopulmonary bypass (CPB). In 1 neonate (weight, 3.2 kg) with critical aortic stenosis, moderate hypothermia and a 3.5-minute period of inflow occlusion and circulatory arrest allowed an aortic valvotomy; in another patient (weight, 7.0 kg) with tricuspid and pulmonary atresia, transposition of the great arteries, and persistent left superior vena cava, a bilateral bidirectional cavopulmonary shunt procedure was performed without CPB. Use of heparin-bonded tubing allowed reduction of the initial dose of heparin sodium to 1 mg/kg. Tissue perfusion and oxygenation on bypass were adequate, as evidenced by a mean lowest pH of 7.38 ± 0.09 and a mean lowest venous oxygen tension of 65.0 ± 36.2 mm Hg. Although the mean postoperative hematocrit (Hct) was lower than the mean preoperative Hct (p < 0.05, analysis of variance and Scheffé's F test), the Hct within 2 hours after CPB was restored to a value (mean Hct, 27.5% ± 1.0%) between the preoperative Hct (mean value, 42.7% ± 3.5%) and the lowest Hct on CPB (mean value, 18.4% ± 1.4%). The Hct at discharge was 31.8% ± 1.1%. The median postoperative blood loss was 9 mL/kg. There was no perioperative mortality. The median stay in the intensive care unit and the hospital was 2 days and 6 days, respectively. We conclude that repair of congenital heart defects with the use of CPB can be safely conducted in select infants with a body weight of 5 kg or more. In symptomatic neonates or infants with a lower body weight, initial palliative procedures circumvent the use of CPB and allow secondary correction of the defect at a later time.
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