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Complications of Cardiopulmonary Bypass in Children after Cardiac Surgery in Senegal

Introduction: Cardiopulmonary bypass (CPB) is a technique for relieving cardiac function by a pump, lung function by an oxygenator and a heat exchanger, after deflecting blood from the heart-lung block. It allows surgery on a heartless and inactive heart. However, it leads to multiple physiological changes in the major functions of the body. Based on these findings, we propose to study the complications secondary to the use of CPB in pediatric cardiac surgery. Materials and Methods: This was a longitudinal, retrospective, descriptive and analytical study of children who benefited from cardiopulmonary bypass during cardiac surgery. It takes place in Dakar from January 16, 2017 to December 31, 2017, for one-year duration at Fann's thoracic and cardiovascular surgery center.Any patient up to 15 years of age who benefited from cardiopulmonary bypass during cardiac surgery during the study period was included. Results: Congenital pathology was dominated by fallot tetralogy (17.65%) and interventricular communication (16.66%). The acquired valvular pathology was dominated by mitral insufficiency (23.53%). Canulation was aortobicave in all our patients. The same SARNS ™ 9000 system perfusion roller console was used as well as membrane oxygenators of the MEDOS® type. The mean duration of CPB in our patients was 103.44 +/- 36.01 minutes [42-205]. Mean duration of aortic cross-clamping was 73.33 +/- 28.3 minutes [17-146]. Duration of assistance was specified in 80 patients (78.4%). It averaged 18.9 +/- 10.25 minutes [6-57]. The total enrollment of our study was 102 patients. A male predominance was noted in our series with 52 boys for 50 girls or a sex ratio of 1.04.The age of our patients ranged from 1.08 to 15 years with an average of 9.41 ± 4.2 years. Post-CPB cardiac complications were marked by metabolic (99%), cardiovascular (37.2%), pleuropulmonary (46.1%), renal (2%), hepatosplanchnic (26.5%), neurological (2 %). The postoperative hemorrhages were 6.9% and the systemic inflammatory response syndrome was found in 48%. One patient died intraoperatively after sternal reopening for hemodynamic instability following tamponade. There were 3 patients (2.9%) who died in the postoperative period. That is a mortality of 3.9% in our series. The postoperative mortality time was 36.33 days on average. The average length of stay in intensive care unit (ICU) was 4.38 days [0.29-30]. Conclusion: Cardiopulmonary bypass allows the replacement or correction of most cardiac and large vessel lesions by perfusion and tissue oxygenation in the absence of cardiac activity. While technical developments have allowed the miniaturization of the material, the artificial surfaces used for such circuits nevertheless remain responsible for an inflammatory reaction that can lead to metabolic disorders and various organ dysfunctions.

Auteur(s) : Momar Sokhna Diop*, Papa Salmane Ba, Papa Amath Diagne, Pape Adama Dieng, Magaye Gaye, Ndeye Fatou Sow, Pape Ousmane Ba, Souleymane Diatta, Moussa Se
Pages : 2329-2334
Année de publication : 2019
Revue : Sholar Journal of Applied Science
N° de volume : 7
Type : Article
Mise en ligne par : DIOP Momar Sokhna dit Sidy Khoya