178 K . Kohlsaat et al .: J Extra Corpor Technol 2023 , 55 , 175 – 184
Table 1 . Patient characteristics / demographics .
|
Standard prime ( n = 417 ) |
PBUF ( n = 704 ) |
P-value |
Age at surgery ( months ) |
3 [ 25d , 6 ] |
3 [ 8d , 6 ] |
0.086 |
Age at surgery 30 days |
109 ( 26 %) |
216 ( 31 %) |
0.12 |
Sex female |
195 ( 47 %) |
328 ( 47 %) |
1.0 |
Premature 1 |
98 ( 24 %) |
139 ( 20 %) |
0.15 |
Palliative procedure |
82 ( 20 %) |
156 ( 22 %) |
0.36 |
1 prior surgery with CPB |
67 ( 16 %) |
98 ( 14 %) |
0.34 |
1 prior surgery without CPB |
30 ( 7 %) |
51 ( 7 %) |
1.0 |
Noncardiac anomaly |
115 ( 28 %) |
206 ( 29 %) |
0.58 |
Chromosomal abnormality |
127 ( 30 %) |
221 ( 31 %) |
0.79 |
Syndrome |
138 ( 33 %) |
221 ( 31 %) |
0.60 |
Preoperative risk factor 2 |
163 ( 39 %) |
308 ( 44 %) |
0.13 |
STAT mortality category 1 |
50 ( 12 %) |
100 ( 14 %) |
0.045 |
2 |
76 ( 18 %) |
108 ( 15 %) |
|
3 |
85 ( 20 %) |
170 ( 24 %) |
|
4 |
172 ( 41 %) |
249 ( 35 %) |
|
5 |
28 ( 7 %) |
72 ( 10 %) |
|
Not assigned |
6 ( 1 %) |
5 ( 1 %) |
|
Urgency status ( n = 413 , 702 ) Elective |
212 ( 51 %) |
319 ( 45 %) |
0.075 |
Urgent |
195 ( 47 %) |
377 ( 54 %) |
|
Emergency |
6 ( 1 %) |
5 ( 1 %) |
|
Salvage |
0 ( 0 %) |
1 (< 1 %) |
|
Cardiopulmonary bypass time ( min ) ( n = 417 , 703 ) |
141 [ 103 , 197 ] |
145 [ 104 , 198 ] |
0.50 |
Cross-clamp time ( min ) ( n = 410 , 688 ) |
91 [ 54 , 128 ] |
93 [ 60 , 125 ] |
0.66 |
Any circulatory arrest time ( n = 410 , 692 ) |
75 ( 18 %) |
128 ( 19 %) |
1.0 |
Operating room time ( min ) |
407 [ 338 , 492 ] |
416 [ 341 , 499 ] |
0.69 |
Intraoperative TPS 3 1 |
279 ( 67 %) |
491 ( 70 %) |
0.55 |
2 |
122 ( 29 %) |
190 ( 27 %) |
|
3 |
5 ( 1 %) |
11 ( 2 %) |
|
4 not assigned |
11 ( 3 %) |
12 ( 2 %) |
|
TPS at discharge 4 1 |
204 ( 49 %) |
367 ( 52 %) |
0.44 |
2 |
118 ( 28 %) |
204 ( 29 %) |
|
3 |
79 ( 19 %) |
113 ( 16 %) |
|
4 Not assigned |
16 ( 4 %) |
20 ( 3 %) |
|
Values shown are number ( percent ) or median [ 25th , 75th percentiles ]. 1 Less than 37 gestational weeks . 2 Preoperative risk factors include : mechanical ventilation , ECMO , renal dysfunction , cardiopulmonary resuscitation , stroke , sepsis , seizures ,
hepatic dysfunction , necrotizing enterocolitis , arrhythmias , colostomy , gastrostomy tube , acidosis , hypothyroidism , bronchopulmonary dysplasia , hypo / hyper coagulable , pulmonary hypertension , adrenal insufficiency , tracheostomy , enterostomy , familial history of ischemic heart disease , endocarditis , asthma , implanted defibrillator , pacemaker , bronchiolitis , single lung , diabetes mellitus type 1 . 3 TPS is classified as Class 1 : no residua ; Class 2 : minor residua ; Class 3 : major residua . 4 TPS is classified as Class 1 : no residua ; Class 2 : minor residua ; Class 3 : major residua or reintervention for residua prior to discharge .
CPB : cardiopulmonary bypass ; Min : minutes ; PBUF : pre-bypass ultrafiltration ; STAT : Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery ; TPS : technical performance score .
of cell lysis and electrolyte composition based on duration and quality of storage . The use of PBUF provides more physiologic values for measured parameters and does so consistently . The method of PBUF used in this study intentionally did not normalize all values , especially the sodium and glucose , since some clinicians were concerned about an increased risk of edema after CPB given that the osmolality , primarily determined by sodium and glucose , decreased relative to the standard blood prime technique . Therefore , our technique of PBUF produced statistically significant improvements in measured values but not truly physiologic values ( although glucose approached clinical significance ), and this was by design . The last values on CPB were statistically similar , with the exception of glucose , and importantly there were no clinically significant differences . While the use of PBUF provided more physiologic prime values for glucose , sodium , potassium , and lactate that were statistically significant when compared to a standard prime , these advantages did not persist throughout the entire duration of the operation . The time spent on bypass was similar between groups and the median bypass time , which was over two hours , was likely sufficient for the patient ’ s compensatory mechanisms to correct most outlier values . Further ,