J Thorac Cardiovasc Surg 2002;124:857
© 2002 The American Association for Thoracic Surgery
Reply
Yves Durandy, MD,
Sylvie Hulin, MD,
Yves Lecompte, MD
ICPS—Institut Jacques Cartier, Avenue du Noyer Lambert, Massy, France
Reply to the Editor:
We thank Corno for his comments on our recent letter. Obviously, normothermic cardiopulmonary bypass associated with warm blood cardioplegia is only part of the perfusion protocol. The flow and the hemoglobin level must be adapted to the systemic oxygen consumption. The quality of the donor blood product must be optimal, but we must also stress the importance of a low volume of priming fluid. We use 180 mL for neonates and infants with a body surface area up to 0.27 m2 (4.5-5 kg) and 225 mL for infants up to 0.42 m2 (8-8.5 kg). We increase this volume progressively to obtain a 600-mL prime volume for children from 0.85 to 1.6 m2 (20-60 kg). With this protocol we never use ultrafiltration during or after bypass.
It is true that most of the surgeons who visited us have been convinced by the advantages of this protocol and have changed their minds about normothermic perfusion. Several surgical units are now using this method. We are reluctant to perform a prospective randomized trial comparing hypothermic and normothermic perfusion. We hope that, in the not too distant future, we will have enough data to publish a single-center or a multicenter experience about normothermic cardiopulmonary bypass in pediatric surgery.
