Rezultatele modificării circuitului cardioplegic în chirurgia malformațiilor cardiace congenitale

Abstract

Obiectivul. Optimizarea cardioplegiei sangvine la copiii cu greutate corporală mică. Material și metode. Pentru minimalizarea circuitului cardioplegic a fost propus un circuit redus (CR), care include doua șunturi 1/8x1/32 cu volum total de umplere de 14ml. Primul șunt este conectat la pompa-seringă cu KCl 2 mEc/ml si al doilea – la canula cardioplegică. Fluxul sanguin pentru alimentarea sistemului era deviat de la oxigenator. Efectul cardioplegiei prin CR (15 pacienți) a fost comparat cu cel al cadioplegiei administrate prin circuit standard (CS, 16 pacienți): pompa cu rotile, tub de 3/16 cu volum de umplere 80ml. Pacienții aveau vârsta 7- 14 luni, greutatea corporala sub 10 kg. Datele investigațiilor nu prezentau diferente semnificative intre grupuri. Au fost comparate timpul stabilirii asistoliei, volumul de priming, cantitatea de concentrat eritrocitar administrat, hematocritul după cardioplegie. Rezultate. Volumul de priming folosit in grupul CS era mai mare fata de cel din grupul CR (350:250). Administrarea cardioplegiei sangvine prin CR a asigurat instalarea stopului cardiac în 29+13 sec., rezultat semnificativ mai mic fata de cel din grupul CS, 45+11 sec. Hematocritul după cardioplegie era fără diferențe semnificative, dar in grupul CS s-a administrat mai mult concentrat eritrocitar (130,5+16,3ml vs 95,8+20,6ml). Menajarea cardioplegiei prin CR s-a dovedit a fi mult mai simplă. Concluzii. Circuitul redus pentru administrarea cardioplegiei sangvine la copii cu greutatea corporala mica permite micșorarea volumului de priming, de concentrat eritrocitar, reducerea suprafețelor artificiale de contact şi asigură stopul cardiac expres. Reducerea circuitului salvează costurile consumabilelor.

Objectives. Optimizing management of blood cardioplegia in children with low body weight. Material and methods. To minimize the cardioplegic circuit was proposed reduced scheme (RC), which includes two shunts 1/8x1/32, whole filling volume of 14ml. The first is connected to the syringe pump with KCl, 2Meq/ ml, and the second - to cardioplegic cannula. Blood flow was supplied from oxygenator. Cardioplegic effect in RC group (15 patients) was compared with that of cadioplegia administered by standard circuit (SC, 16 patients), which includes the roll pump, tube 3/16, filling volume 80ml. Patients were aged 7-14 months, body weight less than 10 kg. Investigation’s data showed no significant differences between groups. Were compared cardiac stop setting time, priming volume, administrated amount of red cells concentrate, hematocrit after cardioplegia. Results. The volume of priming used in SC group was higher than in the RC group (350:250). Administration of blood cardioplegia through RC assured t installation of cardiac arrest in 29+13 sec., significantly lower time than in the SC group, 45+11 sec. There was no significant difference of hematocrit after cardioplegia, but SC group received more red blood cells concentrate (130,5+16,3ml vs 95,8+20,6ml). The management of cardioplegia through RC proved to be much simpler. Conclusions. The RC for blood cardioplegia administration in children with low body weight allows reducing of priming volume, less autologous blood usage, less contact with the artificial surface and provides express cardiac arrest. At the same time, reduces costs of supplies.