Cardiopulmonary bypass in infants and children: How is it different?

Journal of Cardiothoracic and Vascular Anesthesia

Volumn 13, Issue 3, 1999, Pages 330-345

  Davies, Laurie K ^a,b  

^a UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE   (United States)

^b Box 100254 ^*  (United States)

Author keywords

Cardiopulmonary bypass; Heart defects congenital; Hypothermia induced; Infant; Intraoperative care methods; Newborn

Indexed keywords

AIR EMBOLISM; ANESTHETIC EQUIPMENT; BLOOD CLOTTING; CARDIOPULMONARY BYPASS; CARDIOVASCULAR FUNCTION; CHILD; CHOREOATHETOSIS; ELECTROLYTE DISTURBANCE; HEART ARREST; HEART PROTECTION; HEMODILUTION; HUMAN; HYPOTHERMIA; INFANT; OXYGEN CONSUMPTION; PATIENT CARE; PEDIATRIC SURGERY; PRIORITY JOURNAL; REVIEW; ULTRAFILTRATION;

EID: 0032979974     PISSN: 10530770     EISSN: None     Source Type: Journal    
DOI: 10.1016/S1053-0770(99)90274-4     Document Type: Review

References (130)

1. Almond CH, Jones JC, Snyder HM, et al: Cooling gradients and brain damage with deep hypothermia. J Thorac Cardiovasc Surg 48:890-897, 1964
2. Bellinger DC, Wernovsky G, Rappaport LA, et al: Cognitive development of children following repair of transposition of the great arteries using deep hypothermic circulatory arrest. Pediatrics 87:701-707, 1991
3. Mora CT, Henson MB, Weintraub WS, et al: The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization. J Thorac Cardiovasc Surg 112:514-522, 1996
4. Keen EN: The postnatal development of the human cardiac ventricles. J Anat 89:484-502, 1955
5. Friedman WF: The intrinsic physiological properties of the developing heart. Prog Cardiovasc Dis 15:87-111, 1972
6. Baum VC, Palmisano BW: The immature heart and anesthesia. Anesthesiology 87:1529-1548, 1997
7. Klitzner TS: Maturational changes in excitation-contraction coupling in mammalian myocardium. J Am Coll Cardiol 17:218-225, 1991
8. Hickey PR, Crone RK: Cardiovascular physiology and pharmacology in children: Normal and diseased pediatric cardiovascular systems, in Ryan RF, Todres ID, Cote CJ, et al (eds): A Practice of Anesthesia for Infants and Children. Orlando, FL, Grune & Stratton, 1986, pp 176-180
9. Bove EL, Stammers AH: Recovery of left ventricular function after hypothermic global ischemia. Age-related differences in the isolated working rabbit heart. J Thorac Cardiovasc Surg 91:115-122, 1986
10. Newburger JW, Jonas RA, Wernovsky G, et al: A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. N Engl J Med 329:1057-1064, 1993
11. Mavroudis C, Ebert PA: Hemodilution causes decreased compliance in puppies. Circulation 58:1155-1159, 1978 (suppl I)
12. Kirshbom PM, Tsui SS, DiBernardo LR, et al: Pulmonary vascular endothelium is capable of producing nitric oxide after cardiopulmonary bypass and circulatory arrest. J Am Coll Cardiol 25:200A-201A, 1995
13. McGiffin DC, Kirklin JK: Cardiopulmonary bypass, deep hypothermia, and total circulatory arrest, in Mavroudis C, Backer CL (eds): Pediatric Cardiac Surgery. St Louis, MO, Mosby-Year Book, 1994, pp 115-129
14. Swain JA, McDonald TJ, Griffith PK, et al: Low-flow hypothermic cardiopulmonary bypass protects the brain. J Thorac Cardiovasc Surg 102:76-84, 1991
15. Michenfelder JD: The hypothermic brain, in Michenfelder JD (ed): Anesthesia and the Brain. New York, NY, Churchill Livingstone, 1988, pp 23-34
16. Greeley WJ, Kern FH, Ungerleider RM, et al: The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants and children. J Thorac Cardiovasc Surg 101:783-794, 1991
17. Greeley WJ, Ungerleider RM, Kern FH, et al: Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants and children. Circulation 80:1209-1215, 1989 (suppl I)
18. Swain JA: Acid-base status, hypothermia and cardiac surgery. Perfusion 1:231-238, 1986
19. Kern FH, Ungerleider RM, Reves JG, et al: The effect of altering pump flow rate on cerebral blood flow and metabolism in neonates, infants and children. Ann Thorac Surg 56:1366-1372, 1993
20. Bellinger DC, Jonas RA, Rappaport LA, et al: Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med 332:549-555, 1995
21. Clarkson PM, Mac Arthur B A, Barratt-Boyes BG, et al: Developmental progress after cardiac surgery in infancy using profound hypothermia and circulatory arrest. Circulation 62:855-861, 1980
22. Brunberg JA, Reilly EL, Doty DB: Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest. Circulation 50:1160-1168, 1974 (suppl II)
23. Egerton N, Egerton WS, Kay JH: Neurologic changes following profound hypothermia. Ann Surg 157:366-374, 19637
24. Brunberg JA, Doty DB, Reilly EL: Choreoathetosis in infants following cardiac surgery with deep hypothermia and circulatory arrest. J Pediatr 84:232-235, 1974
25. Ames A III, Wright RL, Kowada M, et al: Cerebral ischemia. II. The no-reflow phenomenon. Am J Pathol 52:437-453, 1968
26. Norwood WI, Norwood CR, Castaneda AR: Cerebral anoxia: Effect of deep hypothermia and pH. Surgery 86:203-209, 1979
27. Robinson RO, Samuels M, Pohl KR: Choreic syndrome after cardiac surgery. Arch Dis Child 63:1466-1469, 1988
28. Wical BS, Tomasi LG: A distinctive neurologic syndrome after induced profound hypothermia. Pediatr Neurol 6:202-205, 1990
29. Wessel DL, duPlessis AJ: Choreoathetosis, in Jonas RA, Newburger JW, Volpe JJ (eds): Brain Injury and Pediatric Cardiac Surgery. Boston, MA, Butterworth-Heinemann, 1996, pp 353-362
30. Tharion J, Johnson DC, Celermajer JM, et al: Profound hypothermia with circulatory arrest: Nine years' clinical experience. J Thorac Cardiovasc Surg 84:66-72, 1982
31. Coles JG, Taylor JM, Pearce JM, et al: Cerebral monitoring of somatosensory evoked potentials during profoundly hypothermic circulatory arrest. Circulation 70:196-1102, 1984
32. Ehyai A, Fenichel GM, Bender HW Jr: Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest. JAMA 252:3165-3167, 1984
33. O'Dougherty M, Wright FS, Garmezy N, et al: Later competence and adaptation in infants who survive severe heart defects. Child Dev 54:1129-1142, 1983
34. Rappaport LA, Wypij D, Bellinger DC, et al: Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome. Boston Circulatory Arrest Study Group. Circulation 97:773-779, 1998
35. Kern FH, Greeley WJ: Con: Monitoring of nasopharyngeal and rectal temperatures is not an adequate guide of brain cooling before deep hypothermic circulatory arrest. J Cardiothorac Vase Anesth 8:363-365, 1994
36. Kirshbom PM, Skaryak LA, DiBernardo LR, et al: Effects of aortopulmonary collaterals on cerebral cooling and cerebral metabolic recovery after circulatory arrest. Circulation 92:11490-11494, 1995 (suppl II)
37. Rodriguez RA, Austin EH III, Audenaert SM: Postbypass effects of delayed rewarming on cerebral blood flow velocities in infants after total circulatory arrest. J Thorac Cardiovasc Surg 110:1686-1691, 1995
38. Dietrich WD, Busto R, Valdes I, Loor Y: Effects of normothermic versus mild hyperthermic forebrain ischemia in rats. Stroke 21:1318-1325, 1990
39. Mitani A, Kataoka K: Critical levels of extracellular glutamate mediating gerbil hippocampal delayed neuronal death during hypothermia: Brain microdialysis study. Neuroscience 32:661-670, 1991
40. Kern FH, Ungerleider RM, Quill TJ, et al: Cerebral blood flow response to changes in arterial carbon dioxide tension during hypothermic cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 101:618-622, 1991
41. 2 in fetal, newborn and adult sheep. Am J Physiol 242:H862-H866, 1982
42. Swain JA, McDonald TJ, Robbins RC, Balaban RS: Relationship of cerebral and myocardial intracellular pH to blood pH during hypothermia. Am J Physiol 260:H1640-H1644, 1991
43. Bashein G, Townes BD, Nessly ML, et al: A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass. Anesthesiology 72:7-15, 1990
44. Stephan H, Weyland A, Kazmaier S, et al: Acid-base management during hypothermic cardiopulmonary bypass does not affect cerebral metabolism but does affect blood flow and neurological outcome. Br J Anaesth 69:51-57, 1992
45. Patel RL, Turtle MR, Chambers DJ, et al: Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 111:1267-1279, 1996
46. Murkin JM, Martzke JS, Buchan AM, et al: A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 110:349-362, 1995
47. Hickey PR, Hansen DD: Temperature and blood gases: The clinical dilemma of acid-base management for hypothermic cardiopulmonary bypass, in Tinker J (ed): Cardiopulmonary Bypass: Current Concepts and Controversies. Philadelphia, PA, Saunders, 1989, pp 1-20
48. McConnell DH, White F, Nelson RL, et al: Importance of alkalosis in maintenance of "ideal" blood pH during hypothermia. Surg Forum 26:263-265, 1975
49. Poole-Wilson PA, Langer GA: Effect of pH on ionic exchange and function in rat and rabbit myocardium. Am J Physiol 229:570-581, 1975
50. Swain JA, White FN, Peters RM: The effect of pH on the hypothermic ventricular fibrillation threshold. J Thorac Cardiovasc Surg 87:445-451, 1984
51. Aoki M, Nomura F, Stromski ME, et al: Effects of pH on brain energetics after hypothermic circulatory arrest. Ann Thorac Surg 55:1093-1103, 1993
52. Skaryak LA, Chai PJ, Kern FH, et al: Blood gas management and degree of cooling: Effects on cerebral metabolism before and after circulatory arrest. J Thorac Cardiovasc Surg 110:1649-1657, 1995
53. Kirshbom PM, Skaryak LA, DiBernardo LR, et al: pH-stat cooling improves cerebral metabolic recovery after circulatory arrest in a piglet model of aorto-pulmonary collaterals. J Thorac Cardiovasc Surg 111:147-157, 1996
54. Kurth CD, O'Rourke MM, O'Hara IB: Comparison of pH-stat and alpha-stat cardiopulmonary bypass on cerebral oxygenation and blood flow in relation to hypothermic circulatory arrest in piglets. Anesthesiology 89:110-118, 1998
55. DuPlessis AJ, Jonas RA, Wypij D, et al: Perioperative effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 114:990-1001, 1997
56. Hammon JW, Stump DA, Kon ND, et al: Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg 63:1613-1618, 1997
57. Vannucci RC: Mechanisms of perinatal ischemic brain damage, in Jonas RA, Newburger JW, Volpe JJ (eds): Brain Injury and Pediatric Cardiac Surgery. Boston, MA, Butterworth-Heinemann, 1996, pp 201-214
58. Kirklin JK, Westaby S, Blackstone EH, et al: Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 86:845-857, 1983
59. Shin'oka T, Shum-Tim D, Laussen PC, et al: Effects of oncotic pressure and hematocrit on outcome after hypothermic circulatory arrest. Ann Thorac Surg 65:155-164, 1998
60. Miller BE, Bailey JM, Mancuso TJ, et al: Functional maturity of the coagulation system in children: An evaluation using thromboelastography. Anesth Analg 84:745-748, 1997
61. Eckert H, Gilchrist GS, Stanton R, et al: Hemostasis in cyanotic heart disease. J Pediatr 76:221-230, 1970
62. Manno CS, Hedberg KW, Kim HC, et al: Comparison of the hemostatic effects of fresh whole blood, stored whole blood and components after open-heart surgery in children. Blood 77:930-936, 1991
63. Miller BE, Mochizuki T, Levy JH, et al: Predicting and treating coagulopathies after cardiopulmonary bypass in children. Anesth Analg 85:1196-1202, 1997
64. Royston D: High-dose aprotinin therapy: A review of the first five years' experience. J Cardiothorac Vase Anesth 6:76-100, 1992
65. Boldt J, Knothe C, Zickmann B, et al: Comparison of two aprotinin dosage regimens in pediatric patients having cardiac operations: Influence on platelet function and blood loss. J Thorac Cardiovasc Surg 105:705-711, 1993
66. D'Errico CC, Shayevitz JR, Martindale SJ, et al: The efficacy and cost of aprotinin in children undergoing reoperative open heart surgery. Anesth Analg 83:1193-1199, 1996
67. Mossinger H, Dietrich W: Activation of hemostasis during cardiopulmonary bypass and pediatric aprotinin dosage. Ann Thorac Surg 65:545-851, 1998
68. Davies LK, O'Brien DJ, Lobato EB, et al: Cerebral microemboli in infants and children during cardiac operations. Anesth Analg 84:SCA23, 1997
69. Taylor KM, Morton IJ, Brown JJ, et al: Hypertension and the renin-angiotensin system following open-heart surgery. J Thorac Cardiovasc Surg 74:840-845, 1977
70. Watkins L Jr, Lucas SK, Gardner TJ, et al: Angiotensin II levels during cardiopulmonary bypass: A comparison of pulsatile and nonpulsatile flow. Surg Forum 30:229-230, 1979
71. Stanley TH, Philbin DM, Coggins CH: Fentanyl-oxygen anaesthesia for coronary artery surgery: Cardiovascular and antidiuretic hormone responses. Can Anaesth Soc J 26:168-172, 1979
72. Stanley TH, Berman L, Green O, Robertson D: Plasma catecholamine and cortisol responses to fentanyl-oxygen anesthesia for coronary artery operations. Anesthesiology 53:250-253, 1980
73. Hilberman M, Derby GC, Spencer RJ, Stinson EB: Sequential pathophysiological changes characterizing the progression from renal dysfunction to acute renal failure following cardiac operation. J Thorac Cardiovasc Surg 79:838-844, 1980
74. Gomez-Campdera FJ, Maroto-Alvaro E, Galinanes M, et al: Acute renal failure associated with cardiac surgery. Child Nephrol Urol 9:139-143, 1988
75. Amatayakul O, Cumming GR, Haworth JC: Association of hypoglycaemia with cardiac enlargement and heart failure in newborn infants. Arch Dis Child 45:717-720, 1970
76. Sieber FE, Derrer SA, Saudek CD, Traystman RJ: Effect of hypoglycemia on cerebral metabolism and carbon dioxide responsivity. Am J Physiol 256:H697-H706, 1989
77. Lanier WL, Stangland KJ, Scheithauer BW, et al: The effects of dextrose infusion and head position on neurologic outcome after complete cerebral ischemia in primates: Examination of a model. Anesthesiology 66:39-48, 1987
78. Pulsinelli WA, Waldman S, Rawlinson D, Plum F: Moderate hyperglycemia augments ischemic brain damage: A neuropathologic study in the rat. Neurology 32:1239-1246, 1982
79. Pulsinelli WA, Levy DE, Sigsbee B, et al: Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 74:540-544, 1983
80. Nakakimura K, Fleischer JE, Drummond JC, et al: Glucose administration before cardiac arrest worsens neurologic outcome in cats. Anesthesiology 72:1005-1011, 1990
81. Steward DJ, Da Silva CA, Flegel T: Elevated glucose levels may increase the danger of neurological deficit following profoundly hypothermic cardiac arrest. Anesthesiology 68:653, 1988
82. Burrows FA: Neurologic protection in pediatric cardiac surgery, in Society of Cardiovascular Anesthesiologists 20th Annual Meeting-1998 Workshops, April 25-29, 1998, Seattle, WA
83. Kern FH, Jonas RA, Mayer JE, et al: Temperature monitoring during CPB in infants: Does it predict efficient brain cooling? Ann Thorac Surg 5:749-754, 1992
84. Groom RC, Hill AG, Kurusz M, et al: Paediatric perfusion practice in North America: An update. Perfusion 10:393-401, 1995
85. Chiba Y, Morioka K, Muraoka R, et al: Effects of depletion of leukocytes and platelets on cardiac dysfunction after cardiopulmonary bypass. Ann Thorac Surg 65:107-113, 1998
86. Schmidt FE Jr, MacDonald MJ, Murphy CO, et al: Leukocyte depletion of blood cardioplegia attenuates reperfusion injury. Ann Thorac Surg 62:1691-1696, 1996
87. Gu YJ, deVries AJ, Boonstra PW, van Oeveren W: Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery. J Thorac Cardiovasc Surg 112:494-500, 1996
88. Morioka K, Muraoka R, Chiba Y, et al: Leukocyte and platelet depletion with a blood cell separator: Effects on lung injury after cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg 111:45-54, 1996
89. Hurst T, Johnson D, Cujec B, et al: Depletion of activated neutrophils by a filter during cardiac valve surgery. Can J Anaesth 44:131-139, 1997
90. Lust RM, Bode AP, Yang L, et al: In-line leukocyte filtration during bypass. Clinical results from a randomized prospective trial. ASAIOJ 42:M819-M822, 1996
91. Ihnken K, Morita K, Buckberg GD, et al: Studies of hypoxemic/ reoxygenation injury: Without aortic clamping. II. Evidence for reoxygenation damage. J Thorac Cardiovasc Surg 110:1171-1181, 1995
92. Boiling KS, Halldorsson A, Allen BS, et al: Prevention of the hypoxic reoxygenation injury with the use of a leukocyte-depleting filter. J Thorac Cardiovasc Surg 113:1081-1089, 1997
93. Allen BS, Rahman S, Ilbawi MN, et al: Detrimental effects of cardiopulmonary bypass in cyanotic infants: Preventing the reoxygenation injury. Ann Thorac Surg 64:1381-1387, 1997
94. McAuliffe JJ III: Myocardial preservation, in Lake CL (ed): Pediatric Cardiac Anesthesia (ed 3). Stamford, CT, Appleton & Lange, 1998, pp 259-283
95. Attarian DE, Jones RN, Currie WD, et al: Characteristics of chronic left ventricular hypertrophy induced by subcoronary valvular aortic stenosis. I. Myocardial blood flow and metabolism. J Thorac Cardiovasc Surg 81:382-388, 1981
96. Attarian DE, Jones RN, Currie WD, et al: Characteristics of chronic left ventricular hypertrophy induced by subcoronary valvular aortic stenosis. II. Response to ischemia. J Thorac Cardiovasc Surg 81:389-395, 1981
97. Graham TP Jr, Erath HG Jr, Buckspan GS, Fisher RD: Myocardial anaerobic metabolism during isoprenaline infusion in a cyanotic animal model: Possible cause of myocardial dysfunction in cyanotic congenital heart disease. Cardiovasc Res 13:401-406, 1979
98. Barragry TP, Blatchford JW, Tuna IC, et al: Left ventricular dysfunction in a canine model of chronic cyanosis. Surgery 102:362-370, 1987
99. Visner MS, Arentzen CE, Ring WS, Anderson RW: Left ventricular dynamic geometry and diastolic mechanics in a model of chronic cyanosis and right ventricular pressure overload. J Thorac Cardiovasc Surg 81:347-357, 1981
100. Bernstein D, Voss E, Huang S, et al: Differential regulation of right and left ventricular beta-adrenergic receptors in newborn lambs with experimental cyanotic heart disease. J Clin Invest 85:68-74, 1990
101. DeLeon SY, Idriss FS, Ilbawi MN, et al: Comparison of single versus multidose blood cardioplegia in arterial switch procedures. Ann Thorac Surg 45:548-553, 1988
102. Sawa Y, Matsuda H, Shimazaki Y, et al: Comparison of single-dose versus multiple-dose crystalloid cardioplegia in neonates. Experimental study with neonatal rabbits from birth to 2 days of age. J Thorac Cardiovasc Surg 97:229-234, 1989
103. Young JN, Choy IO, Silva NK, et al: Antegrade cold blood cardioplegia is not demonstrably advantageous over cold crystalloid cardioplegia in surgery for congenital heart disease. J Thorac Cardiovasc Surg 114:1002-1009, 1997
104. Magovern GJ, Flaherty JT, Gjott VL, et al: Failure of blood cardioplegia to protect myocardium at lower temperatures. Circulation 66:I60-I67, 1982 (suppl I)
105. Rich TL, Brady AJ: Potassium contracture and utilization of high-energy phosphates in the rabbit heart. Am J Physiol 226:105-113, 1974
106. Frank JS, Rich TL, Beydler S, Kreman M: Calcium depletion in rabbit myocardium: Ultrastructure of the sarcolemma and correlation with the calcium paradox. Circ Res 51:117-130, 1982
107. Pearl JM, Laks H, Drinkwater DC, et al: Normocalcemic blood or crystalloid cardioplegia provides better neonatal myocardial protection than does low-calcium cardioplegia. J Thorac Cardiovasc Surg 105:201-206, 1993
108. Kempsford RD, Hearse DJ: Protection of the immature myocardium during global ischemia. A comparison of four clinical cardioplegic solutions in the rabbit heart. J Thorac Cardiovasc Surg 97:856-863, 1989
109. Yonenaga K, Yasui H, Kado H, et al: Myocardial protection by retrograde cardioplegia in arterial switch operation. Ann Thorac Surg 50:238-242, 1990
110. Ungerleider RM, Greeley WJ, Sheikh KH, et al: The use of intraoperative echo with Doppler color-flow imaging to predict out-come after repair of congenital cardiac defects. Ann Surg 210:526-533, 1989
111. The Task Force on Perioperative Transesophageal Echocardiography: Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology 84:986-1006, 1996
112. Laks H, Pearl JM, Haas GS, et al: Partial Fontan: Advantages of an adjustable interatrial communication. Ann Thorac Surg 52:1084-1095, 1991
113. Kern FH, Schulman SR, Lawson DS, Darling EM: Extracorporeal circulation and circulatory assist devices in the pediatric patient, in Lake CL (ed): Pediatric Cardiac Anesthesia (ed 3). Stamford, CT, Appleton & Lange, 1998, pp 219-257
114. Kanter KR, Pennington G, Weber TR, et al: Extracorporeal membrane oxygenation for postoperative cardiac support in children. J Thorac Cardiovasc Surg 93:27-35, 1987
115. Weinhaus L, Canter C, Noetzel M, et al: Extracorporeal membrane oxygenation for circulatory support after repair of congenital heart defects. Ann Thorac Surg 48:206-212, 1989
116. Rogers AJ, Trento A, Siewers RD, et al: Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children. Ann Thorac Surg 47:903-906, 1989
117. Klein MD, Shaheen KW, Whittlesey GC, et al: Extracorporeal membrane oxygenation for the circulatory support of children after repair of congenital heart disease. J Thorac Cardiovasc Surg 100:498-505, 1990
118. Naik SK, Elliott MJ: Ultrafiltration and pediatric cardiopulmonary bypass. Perfusion 8:101-112, 1993
119. Elliott MJ: Ultrafiltration and modified ultrafiltration in pediatric open-heart operations. Ann Thorac Surg 56:1518-1522, 1993
120. Naik SK, Knight A, Elliott MJ: A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 84:111422-01431, 1991
121. Friesen RH, Campbell DN, Clarke DR, Tornabene MA: Modified ultrafiltration attenuates dilutional coagulopathy in pediatric open-heart operations. Ann Thorac Surg 64:1787-1789, 1997
122. Davies MJ, Nguyen K, Gaynor JW, Elliott MJ: Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:361-370, 1998
123. Bando K, Vijay P, Turrentine MW, et al: Dilutional and modified ultrafiltration reduces pulmonary hypertension after opera-tions for congenital heart disease: A prospective randomized study. J Thorac Cardiovasc Surg 115:517-527, 1998
124. Meliones JN, Gaynor JW, Wilson BG, et al: Modified ultrafiltration reduces airway pressure and improves lung compliance after congenital heart surgery. J Am Coll Cardiol 25:271 A, 1995
125. Millar AB, Armstrong L, van der Linden J, et al: Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass. Ann Thorac Surg 56:1499-1502, 1993
126. Andreasson S, Gothberg S, Berggren H, et al: Hemofiltration modifies complement activation after extracorporeal circulation in infants. Ann Thorac Surg 56:1515-1517, 1993
127. Skaryak LA, Kirshbom P, DiBernardo LR, et al: Modified Ultrafiltration improves cerebral metabolic recovery after circulatory arrest. J Thorac Cardiovasc Surg 109:744-752, 1995
128. Darling E, Nanry K, Shearer I, et al: Techniques of paediatric modified ultrafiltration: 1996 survey results. Perfusion 13:93-103, 1998
129. Ungerleider RM: Effects of cardiopulmonary bypass and use of modified ultrafiltration. Ann Thorac Surg 6S:S35-S39, 1998
130. Kern FH, Greeley WJ: pH-stat management of blood gases is not preferable to alpha-stat in patients undergoing brain cooling for cardiac surgery. J Cardiothorac Vase Anesth 9:215-218, 1995