2nd World Heart Congress
Chief Perfusionist, Rainbow Babies & Children’s Hospital, USA
Title: Cardiopulmonary bypass for neonates and infants
Biography: Jacob Ostrowsky
Cardiopulmonary bypass (CPB) enables surgical correction of congenital heart defects by diverting the patient circulation around the area that requires repair. Used along with myocardial arresting solution, the surgeon is able to work in a bloodless and motionless operative field. The heart-lung machine has been used for more than 60 years and has undergone a multitude of improvements to the device itself. In addition, the artificial organ components that make up the extracorporeal circuit have improved dramatically. The techniques used to manage CPB have taken great strides to reduce and eliminate the negative sequelae that have been historically linked to these procedures. The commitment of manufacturers to improving equipment and disposables is a key element, but the techniques used by the caregiver managing the system are paramount to providing the best possible protection for patients during CPB. Circuit miniaturization, fluid management and site specific monitoring all contribute to safe and consistent results. The need for strict attention to detail is emphasized in the neonatal and infant population. Special attention is paid to techniques that can reduce edema, improve hemostasis, protect organ function and markedly decrease the need for homologous donor blood component therapy. Historical benchmarks for outcomes, related only to mortality, are no longer an acceptable standard. The evolution of outcomes begets the need to stratify and analyze results to give every patient the ability to reach their best quality of life based on their individual baseline potential. This presentation will discuss our approach to neonatal and infant CPB at Rainbow Babies & Children’s Hospital to facilitate improved outcomes in the surgical correction of congenital heart defects.