CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
12
AFRICA
since October 2011. CVL audit compliance has improved from 86 to
100% since July 2011. SSI infections 30 days post cardiac surgery
have reduced from 8 to 2% since November 2011
Conclusions:
Our BUG BUSTERS themed initiative has led to
increased awareness of infection control issues and contributed to a
reduction in infection rates of children in CICU.
173: CONTROLLING OXYGENATION DURING INITIA-
TION OF CARDIOPULMONARY BYPASS: EFFECT ON
RENAL AND HEPATIC SYSTEMS IN CYANOTIC CHIL-
DREN UNDERGOING CARDIAC SURGERY
Balram Babu Rajanbabu
1,2
, Seetharam Bhat
2
, Libu Gnanaseelan
Kanakamma
3
, Shilpa Suresh
4
, Giridhar Kamalapurkar
2
, Honnekare
Venkataiah Jayanth Kumar
2
, Bhuvanahalli Karigowda Lokesh
4
, Kiran
Shankar Uday
1
1
Department of Cardiothoracic Surgery, Apollo Hospitals, Bangalore,
India
2
Department of Cardiothoracic Surgery, Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Trivandrum, India
3
Department of Community Medicine and Statistics, Karakonam
Medical College, Trivandrum, India
4
Department of Clinical Perfusion,Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Trivandrum, India
Objective:
Cardiopulmonary bypass (CPB) initiated with high
oxygen levels exposes cyanotic children to reoxygenation injury,
which can affect multiple organ systems. Controlling oxygenation
during initiation of cardiopulmonary bypass has been demonstrated
to be associated with decreased myocardial injury. This study tested
the effect of this strategy on the renal and hepatic systems.
Methods:
Thirty-one cyanotic children were randomised to group A
(intervention) and group B (hyperoxaemic). CPB was initiated with a
fraction of inspired oxygen (FIO
2
0.21), and after one minute of full
bypass, FIO
2
was increased at increments of 0.1 per minute to reach
0.6. In group B, CPB was initiated using FIO
2
>
0.6. Aortic cross-
clamp and CPB time (minutes) was measured. Serum creatinine (mg/
dl), aspartate aminotransferase (AST) (U/l) and alanine aminotrans-
ferase (ALT) (U/l) were measured pre-operatively (Pre-op) and on
postoperative days (POD) 1 and 2.
Results:
CPB time (group A median
=
71.5, IQR
=
64–100; group B
median
=
95.5, IQR
=
58–145,
p
=
0.71), cross-clamp time (group A
mean
=
59.2, 95% CI
=
47.6–70.8; group B mean
=
66.57, 95% CI
=
47.6–88.5,
p
=
0.57).
Serum creatinine [Pre-op (group A median
=
0.6, IQR
=
0.53–
0.68; group B median
=
0.6, IQR
=
0.6–0.7,
p
=
0.11), POD-1 (group
A median
=
0.6, IQR
=
0.5–0.76; group B median
=
0.6, IQR
=
0.5–0.75,
p
=
0.54), POD-2 (group A median
=
0.5, IQR
=
0.43–0.68;
group B median
=
0.6, IQR
=
0.5–0.77,
p
=
0.11)].
AST [Pre-op (group A mean
=
27.5, 95% CI
=
24.91–30.09;
group B mean
=
31.31, 95% CI
=
25–37.64,
p
=
0.37), POD-1 (group
A median
=
100, IQR
=
83–132; group B median
=
103, IQR
=
74.75–146,
p
=
0.8), POD-2 (median
=
66.5, IQR
=
52–76.25; group
B median
=
82, IQR
=
62–124.75,
p
=
0.12)].
ALT [Pre-op (group A median
=
18.5, IQR
=
15.25–19.75; group
B median
=
17.5, IQR
=
13.25–22.50,
p
=
0.84) and POD-1 (group
A median
=
21, IQR
=
19–23; group B median
=
24.50, IQR
=
19.5–34.5,
p
=
0.19] showed no significant difference.
ALT: POD-2 (group A median 19.5, IQR
=
16–21; group B medi-
an
=
25, IQR
=
21–33,
p
=
0.044) was significantly lower in group A.
Conclusion
: This study suggests possible decreased hepatic injury
associated with this protocol.
184: IMPACT OFAFTERLOAD REDUCTION ON CEREBRAL
TISSUE OXYGENATION AFTER THE NORWOOD PROCE-
DURE FOR HYPOPLASTIC LEFT HEART SYNDROME
Jan Hinnerk Hansen, Jana Schlangen, Olaf Jung, Jens Scheewe,
Hans-Heiner Kramer
University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Background
: Lower cerebral tissue oxygenation has been observed
by near infrared spectroscopy (NIRS) after the Norwood procedure.
Altered cerebral vascular resistance and pharmacological afterload
reduction redirecting blood flow away from the cerebral circula-
tion are possible mechanisms. We evaluated the impact of afterload
reduction with Milrinone on cerebral (cSO
2
) and somatic tissue
oxygenation (sSO
2
) in comparison to retrospective controls treated
with sodium-nitroprussid and enoximone.
Methods
: NIRS and routine intensive care monitoring data were
recorded for 24 hours before and 48 hours after the Norwood
procedure in 68 hypoplastic left heart syndrome (HLHS) patients
(milrinone
n
=
34, control
n
=
34). Average values of the last four pre-
operative hours (baseline) and of the first and last four postoperative
hours (early and late course) were calculated.
Results
: Baseline, early and late postoperative cSO
2
values were 58
±
7%, 52
±
12% and 61
±
7% for patients treated with milrinone and
58
±
7%, 52
±
9% and 60
±
6% for controls; sSO
2
values were 58
±
9%, 78
±
8% and 69
±
10% and 59
±
8%, 76
±
10% and 67
±
9%,
respectively. Baseline and postoperative NIRS values were not differ-
ent between groups. cSO
2
was below 40% for 45 (0–720) minutes
in patients treated with milrinone and for 50 (0–1 040) minutes in
controls (
p
=
1.00). A lower haemoglobin level early after operation
was associated with cSO
2
<
40% for more than 60 minutes (14.9
±
1.7 vs 16.0
±
1.3 g/dl,
p
=
0.005). cSO
2
correlated with pO
2
(
r
: 0.137,
p
<
0.001), with SaO
2
(
r
: 0.223,
p
<
0.001), and with SvO
2
(
r
: 0.404,
p
<
0.001). pCO
2
was weakly and negatively correlated with sSO
2
(
r
:
–0.165,
p
<
0.001), but not with cSO
2
.
Conclusions
: Early after the Norwood procedure, cSO
2
was lowered
with both strategies of afterload reduction and the wide difference
between cSO
2
and sSO
2
indicates a mismatch between cerebral and
splanchnic perfusion. Other strategies to improve cerebral tissue
oxygenation after the Norwood procedure are needed.
187: TRUNCUS ARTERIOSUS COMMUNIS REPAIR WITH
OR WITHOUT RIGHT VENTRICLE-TO-PULMONARY
ARTERY CONDUIT: NO DIFFERENCE IN EARLY AND
MID-TERM FOLLOW UP
Peter Skrak, Martin Zahorec, Lubica Kovacikova
Pediatric Cardiac Center, Bratislava, Slovak Republic
Background:
Implantation of a conduit between the right ventricle
and pulmonary artery is a part of the truncus arteriosus communis
(TAC) repair in many centres. Repair without a conduit was imple-
mented in our centre to decrease the re-intervention rate. The aim
of the study was to compare early and mid-term results of conduit
versus non-conduit repair of the TAC and to assess risk factors for
mortality and prolonged hospital stay (
>
30 days).
Methods:
All patients who underwent two-ventricle repair of TAC
between 1995 and 2012 were included in a retrospective cohort study
and divided into conduit (
n
=
12) and non-conduit (
n
=
20) groups.
The conduit was implanted at the discretion of the surgeon. Data are
presented as median (range).
Results:
The age at surgery was 28 days (6–466). The mortality rate
was 21.8% (
n
=
7). There was no difference between the conduit and
non-conduit groups in weight, age at surgery, classification accord-
ing to aortic versus pulmonary dominance, and duration of intensive
care, inotropic support, mechanical ventilation and mortality rate.
Cardiopulmonary bypass time and cross-clamping time were longer
in the conduit group: 154 minutes (120–513) versus 107 minutes
(84–197),
p
=
0.006; and 91 minutes (48–160) versus 65 minutes
(31–108),
p
=
0.01, respectively. Truncal valve repair with aortic
conduit was required in two patients in the conduit group. Five
patients required seven surgical re-interventions in the non-conduit
group and one patient required an interventional procedure in the
conduit group until hospital discharge (
p
=
0.27). One- and five-year
freedom from right ventricle outflow tract re-intervention was 80 and
53% in the conduit group and 80 and 80% in the non-conduit group,
respectively (
p
=
0.16). No risk factors for mortality were identified.
The needs for mechanical ventilation at the time of surgery and for
