Index

Note: Page numbers in italics refer to Figures; those in bold to Tables.

activated clotting time (ACT), 35–9 interrupted aortic arch, 121 Blalock–Taussig shunt (BTS), 95, 114, Alfieri stitch, 172 luminal variation, 24, 25 115, 117, 129, 142, 149, 152, 155, alpha-stat blood gas management see placement, 79–80 159, 173, 177, 180 blood gas management regional perfusion strategies, 52–4, 115 blood coagulation see anticoagulation anomalous aortic origin of a coronary arterial decannulation, inadvertent, 73, management artery (AAOCA), 88 170 blood gas management anomalous left coronary artery from the arterial head occlusion, 29–30 alpha-stat management, 40–44 (ALCAPA), 86 arterial line filters (ALF) on bypass, 80–81 anticoagulation management blood flow path, 13, 13 oxygenation strategy, 42–4 activated clotting time (ACT), 35–9 external, 12, 12, 13, 14, 61–2 pH-stat management, 40–44 blood coagulation pathways, 35, 35, 36 integral, 5–8, 9 blood pressure management coagulation factors, 35, 35 arterial pump failure (roller head), 164 , 47–8 heparin concentration management, 37 arterial switch operation (ASO), 85, 112, cerebral blood flow (CBF), 47 prime volume 140, 141, 174–7 see also Jatene higher than expected, 148 circuit exposure, 36 procedure lower than expected, 149 examples, 14, 187, 188 arterio venous MUF (AVMUF), 56–9, 57 ranges, 48, 48 oxygenator primes, 5–8 atrial line, 77 blood prime see also priming procoagulant factors, 35, 36 placement, 82 blood volume, 31, 31 protamine dosing, 38–9 atrial septal defects (ASDs), 95–8, 97, 102, calcium and sodium bicarbonate, 31–2 surface-modifying agents (SMAs), 36 110, 121, 128, 129, 132, 133, 138, dilutional hematocrit, 30 , acute, 73, 168 140, 142, 176 hematocrit of blood product, 31 (AI), 74, 80, 89–90 augmented venous return prebypass filter, 30 aortic regurgitation (AR) see aortic kinetic-assisted venous drainage pump prime, 30–2 insufficiency (KAVD), 60–61 Brock procedure, 173 aortic stenosis (AS) roller pump-assisted venous drainage, 60 bypass plan critical, 107, 107–8 vacuum-assisted venous drainage anticoagulation management, 35–9 subvalvar/subaortic, 91 (VAVD), 61–2 augmented venous return, 60–62 supravalvar, 91, 92 blood gas management, 40–44 valvar, 91, 92 , 172 blood pressure management, 47–8 aortopulmonary collaterals (APCs), 41,COPYRIGHTED bed rotation, 83, 148, 149 MATERIALclosed-loop communication, 33 93–4, 94, 130, 136 , 172 flow rates, 52 aortopulmonary window, 95, 95 bicaval cannulation, 20–23 hematocrit management, 45–6 arterial blood pressure management, 47, bidirectional Glenn (BDG) shunt, 114, hypothermic circulatory arrest, 52–4 48, 52, 148, 149, 168 116, 117, 172 methods of ultrafiltration, 55–9 arterial cannulae bilateral bidirectional Genn shunt prebypass checklist, 63, 63–4, 64 central aortic cannulation, 23–4, 24, 24 (BBDG), 117, 172 regional perfusion, 52–4 femoral cannulation, 25, 25 Blalock–Hanlon procedure, 172–3 standard venous return, 60

Perfusion for Congenital : Notes on Cardiopulmonary Bypass for a Complex Patient Population, First Edition. Gregory S. Matte. © 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.

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surgical safety checklist, 65–6 factors, 35, 35 d-transposition of the great arteries temperature management, 49–51 pathways, 35, 35 (d-TGA), 45, 112, 140–141, 141, phases, 35, 36 175, 176, 178 cannulae coarctation of the (CoA), aortic arch anatomy, 20, 21 100–101, 101 Ebstein’s anomaly, 113, 113, 143, 173 arterial, 23–5, 24, 24, 25, 25, 79–80 colloidal primes, 27–8 emergency procedures cardiac anatomy, 20, 21 commencement of bypass acute aortic dissection, 168 central venous anatomy, 20, 21 arterial clamp removal, 73 arterial decannulation, pressure loss, 21–2, 23–4 cannulation, 72–3 inadvertent, 170 venous, 22, 22–3, 23 cooling, 74 arterial pump failure water charts, 22 full flow, 74 (roller head), 164 cannulation full scanning, 74 failure to oxygenate, 165 arterial cannula, 79–80 gas flow, 73 massive air embolus (MAE), 166–7 bicaval, 80 pump suckers, 72 venous air lock, 169 central aortic, 23–4, 24, 24 venous cannula, 73 venous decannulation, inadvertent, 171 femoral, 25, 25 complete atrioventricular canal (CAVC), endotracheal tube (ETT) for SVC pump lines, 79, 80 45, 102–3, 103 cannulation, 96, 96 transfusion, 80 cone procedure, 113, 173 equipment carbon dioxide flush, 29 congenitally corrected transposition of arterial line filters, 12–3 carbon dioxide management the great arteries (CCTGAs), 105, cannulae, 20–25 alpha-stat blood gas management, 40 105–6, 106 systems, 16–7 carbair/carbogen option, 43–4 continuous cardioplegia systems, 17 heart–lung machine (HLM), 17–9 crossover strategy, 42 conventional ultrafiltration (CUF), 55, heater-cooler system, 19–20 pH-stat blood gas management, 40–42 59, 75 oxygenators, 1–12 cardiac index, 52–4, 52 coronary sinus septal defect (CSSD), 96 selection chart, experience-based, 14, cardiomyopathy (CMO) Cor triatriatum, 104, 104 187, 188 Batista procedure, 172 Cox maze procedure, 173 tubing packs, 13–16 orthotopic , 99 cross-clamp time (CCT), 78 cardioplegia (CPG) systems crossover technique femoral cannulation, 23–5, 25 continuous, 17 for carbon dioxide management, 42 filtration systems, 9, 10 during standard support phase, 74–5 for oxygenation strategy, 43 flow rates equipment, 16–7 crystalloid during bypass, 52–4, 52 nonrecirculating, 17, 81, 89 heparin level, 30 oxygenator gas flow, 5–8 recirculating, 16, 16–7, 75, 81, 89 prebypass filter, 30 priming, 29–30 cardiopulmonary bypass time primes, 27–30, 28 water, 11, 19, 23–5, 23 (CPBT), 78 , 110, 114, 119–20, filter, 2, 3, 9, 10–11 Damus–Kaye–Stansel anastomosis, 173 142, 174 cardiotomy venous reservoir (CVR), 2, deep hypothermic circulatory arrest 3, 9, 9 (DHCA), 50, 52–4, 165, gas flow rates, 40–42, 73, 90, 124, 155, caval tapes, 80 167, 168 157, 159–60 cavopulmonary anastomosis, 114, 116, defoaming agents, 9–11 Gott shunt, 174 117, 119, 172, 174, 180 dilutional ultrafiltration (DUF), 55–6, 59, Great Ormond Street Hospital MUF cell-based model of hemostasis, 102, 113, 125, 143 method (GOSH method), 35–6, 36 display systems, 19 56–8, 57 central aortic cannulation, 23–4, 24, 24 double-chambered right central shunt, 173 (DCRV), 109 heart–lung machine (HLM) central venous pressure (CVP), 73, 75, 77, double inlet left ventricle (DILV), components, 17–9 153, 161 110, 146 prebypass positioning, 79 cerebral perfusion pressure (CPP), 47 double-orifice technique see Alfieri heart transplantation, 99 cerebral vascular resistance, 47 stitch heater-cooler system circulatory arrest time (CAT), 52–4, 78 double outlet left ventricle (DOLV), 111 standalone heater-cooler unit, 19 closed bypass systems, 9 double outlet right ventricle (DORV), 85, Stockert heater-cooler system 3T, coagulation, see anticoagulation 112, 112, 178 20, 20 management double switch procedure, 105, 173–4 “wall water,” 20

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heat exchange issue (slow cooling or levo transposition of the great arteries integrated ALF, 9 warming), 154 see congenitally corrected membrane heat exchanger transposition of the great blood flow paths, 4, 4 sizes, 5–8 arteries microporous, 1, 3, 4 performance factor, 11 lung transplantation, 124, 134 pressure drop, 4, 9 temperature gradients, 11 LV vent true, 1, 3 hematocrit management, 45–6 with aortic insufficiency, 89 Terumo CAPIOX FX series, 1, 2, 3, 9, 5–8 Hemi–Fontan procedure, 116, 117, 174 placement, 75, 83 oxygen toxicity, 42 hemofiltration, 55–9

heparin major aortopulmonary collateral arteries PaCO2 see blood gas management anticoagulation management, 35–9 (MAPCAs), 1, 10, 81, 93, 94, 95, Pannus, 176

antithrombin III level, 37 129, 130, 136, 138, 144 PaO2 see blood gas management crystalloid prime concentration, 30 Manougian procedure, 175 partial atrioventricular canal defect dosage, 37 Marfan’s syndrome, 175 (PAVC), 102 HDR curve, 37, 38 massive air embolus (MAE) patent ductus arteriosus, 74, 107, 121, 127, reversing anticoagulation effect, 38–9 operative measures, 166 127, 129, 130 heparin-dose response (HDR) curve, postoperative plan, 167 Pentalogy of Cantrell, 176 37–8, 38 vacuum-assisted venous drainage persistent left superior vena cava see left Holmes heart, 174 (VAVD), 61–2 superior vena cava hyperoxic technique, 43–4 maze procedure see Cox maze procedure phases of bypass hypoplastic left heart syndrome (HLHS), medications for bypass, 187, 189 bypass times, 78 114–20, 114 microplegia see continuous cardioplegia commencement, 72–4 bidirectional Glenn Shunt, 116, 117, systems post bypass, 78 172 mitral regurgitation/insufficiency (MR/ standard support phase, 74–6 Fontan procedure, 119, 119–20, 174 MI), 86, 125, 125, 172 termination, 76–7 hybrid stage 1 palliation, 117 mitral stenosis (MS), 126, 126, 178 pH-stat blood gas management see blood stage 2 or bidirectional Glenn shunt, modified BTS (mBTS) see Blalock– gas management 117–8, 116 Taussig shunt Potts shunt, 177 stage 1 procedure, 115, 115–7 modified ultrafiltration (MUF), 56–9, 56 prebypass hypothermic circulatory arrest (HCA), 43, GOSH MUF technique, 56, 57, 57–8 cannulation, 79–80 52–4 simplified (SMUF), 56–9 checklist, 63, 63–4, 64 , 176 heart–lung machine (HLM), 79 induced fibrillation time (IFT), 78 reoperations, 79 induced ventricular fibrillation, 75, 78, 82, near-infrared spectroscopy (NIRS), 42, transfusion during cannulation, 80 96, 105, 113, 119, 132, 146 50, 53, 100, 124, 127, 152–3, prebypass ultrafiltration (PBUF), 55 interrupted aortic arch (IAA), 121, 121–2 155–6, 167 priming ischemic reperfusion damage, 43 Nicks procedure, 176 blood prime, 28, 30–32 Nikaidoh procedure, 140, 176 carbon dioxide flush, 29 Jatene procedure see arterial switch Noonan syndrome, 176 clear primes, 27–8, 28 operation normoxic technique, 43 common prime constituents, 28 Norwood operation, 114–5, 115, 176 crystalloid prime, 29–30 Kawasaki disease, 174 prime selection, 28–9 Kawashima procedure, 175 orthotopic heart transplantation, 99 prime of circuits, 14, 188 kinetic-assisted venous drainage (KAVD), oxygenation strategy prime volume of tubing, 15, 15 60–62, 61 crossover technique, 43 water testing, 29 Kommerell’s diverticulum, 175 hyperoxic strategy, 43 protamine Konno procedure, 175 ischemic reperfusion damage, 43 administration, 38, 39, 78 microembolic events, 42 empiric dosing, 38 LeCompte procedure, 175 normoxic strategy, 42 HDR curve, 38 left superior vena cava (LSVC), 22, 96, 97, oxygen toxicity, 42 titration dosing, 38–9 123, 123 oxygenators pulmonary artery abnormalities, 128, 128 left ventricular outflow tract obstruction available models, 5–8 pulmonary atresia (PA) (LVOTO), 91, 107, 112, 175, components, 1–12, 5–8 with an intact ventricular septum 176, 179 failure, 165 (PA/IVS), 129, 129

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TOF, 136 second-stage procedure see bidirectional tricuspid atresia, 142, 142, 146, 147 with ventricular septal defect (PA/ Glenn (BDG) shunt tricuspid regurgitation/insufficiency VSD), 130–131, 131 Senning operation, 177 (TR/TI), 143, 143 pulmonary regurgitation/insufficiency Shone’s complex, 178 truncus arteriosus (TA), 45, 144, (PR/PI), 132, 132 shunts, external/internal, 1, 149, 152, 144–5, 145 pulmonary stenosis, 111, 127, 133, 133, 155, 157 Trusler repair, 178 173–7 simplified modified ultrafiltration tubing packs, 13–6, 14, 188 pulmonary vein stenosis (PVS), 134–5, (SMUF) see modified 135 ultrafiltration ultrafiltration methods pulmonary venous obstruction see sinus venosus, 96, 97, 138, 177, 178 after bypass, MUF and SMUF, 56–9 pulmonary vein stenosis stage 1 procedure see Norwood operation on bypass, CUF, DUF and ZBUF, 55 stage 2 procedure, see bidirectional before bypass, PBUF, 55 Q10, concept, 49–50 Glenn shunt stage 3 procedure see Fontan procedure vacuum-assisted venous drainage Rashkind procedure, 177 standard support phase of bypass, 74–6 (VAVD), 61–2, 166 Rastelli operation, 140, 141, 175, 177 Stockert heater-cooler system 3T, 20, 20 Van Praagh classification, 178 regional cerebral and coronary circulation subaortic stenosis, 91–2, 92 venous air lock, 169 (RCCP), 53 supravalvar aortic stenosis, 92, 176 venous cannulae regional cerebral, coronary, and surface modifying agents (SMAs), 28, 36 bicaval cannulation, 22, 22–3 splanchnic perfusion (RCCSP), 53 surgical safety checklist, 65, 65–6 Medtronic DLP angled metal regional cerebral perfusion (RCP), 52–4 systemic vascular resistance (SVR), tip, 22, 22 regional low-flow perfusion (RLFP) 148–52 water chart flow rates, 23, 23 aortic arch reconstruction, 52, 52 venous decannulation, inadvertent, 171 three-region perfusion strategy, 53, 53 Takeuchi procedure, 178 venous reservoirs, 2, 3, 9–10, 9, 5–8 regional perfusion time (RPT), 78 Taussig–Bing anomaly, 178 venous return, 60–62 reservoir volume, 15, 55, 58, 62, 76–7, 91, temperature management ventricular septal defect (VSD), 146, 107, 161, 169, 171 concept of Q10, 49–50 146–7, 147 revolutions per minute (RPMs), 15, cooling and warming, 50–51 61, 164 hypothermia, myocardial protection, 51 Warden procedure, 178 rewarming, 24, 28, 50–51, 75–6, 81–3, 88, temperature ranges, 49 Waterston shunt, 178 90, 99–100, 140 see also standard termination of bypass, 76–7 weaning process, 19, 24, 76–7, 136, 138 support phase Tetralogy of Fallot (TOF), 45, 85, 93, 111, Williams syndrome, 178 right ventricular-dependent coronary 112, 130, 132, 133, 136, 136–7, Wolff–Parkinson–White (WPW) circulation (RVDCC), 129 137, 173, 176 syndrome, 113 roller pump-assisted venous drainage, 60 total anomalous pulmonary venous return , 177 (TAPVR), 134, 138, 139 Yasui procedure, 179 total/partial anomalous pulmonary , 114, 115, 115, 117, 177 venous connection (TAPVC/ zero-balance ultrafiltration (ZBUF), 55–6, Scimitar syndrome, 96, 138, 177 PAPVC), 138–9, 139 59, 75, 102, 113, 125, 143

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