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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 pulmonary artery (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 cardiopulmonary bypass, 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 aortic dissection, acute, 73, 168 140, 142, 176 hematocrit of blood product, 31 aortic insufficiency (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 Batista procedure, 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 Bentall procedure, 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 Heart Surgery: 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. 190 0002262967.indd 190 1/27/2015 5:29:40 PM Index 191 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 aorta (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 cardioplegia 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 heart transplantation, 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 Fontan procedure, 110, 114, 119–20, cardiotomy 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 ventricle 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 0002262967.indd 191 1/27/2015 5:29:40 PM 192 Index 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 Mustard procedure, 176 heart–lung machine (HLM), 79 induced fibrillation time (IFT), 78 reoperations, 79 induced ventricular fibrillation,