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Subject Area

Pediatrics

Article Type

Original Study

Abstract

Objective The study aimed to compare neurological complications, pulmonary gas exchange, and mortality among children with congenital heart disease after nonbypass versus bypass cardiac surgery. Background Whether off-pump cardiac surgical procedures have less pulmonary gas exchange problems, neurological complications, and less mortality compared with operations involving cardiopulmonary bypass is debatable. We compared these outcome parameters in comparable groups of children who have undergone cardiac surgical procedures with or without cardiopulmonary bypass in our center. Patients and methods A total of 129 patients who underwent congenital heart surgery were allocated into two groups: group 1 underwent nonbypass cardiac surgery (n = 51), and group 2 underwent bypass cardiac surgery (n = 78). Pulmonary gas exchange was assessed using the alveolar-arterial oxygen gradient (A-aO2), partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), and respiratory index (RI). Patients were observed for the development of acute neurologic complications (ANCs) for 30 days after cardiac surgery. Results We found more acute deterioration in A-aO2 gradient (mean ± SD, 114.28 ± 193.77) and RI (mean ± SD, 316.03 ± 506.38) in the bypass group as compared with the nonbypass group (mean ± SD, A-aO2 gradient of 41.63 ± 65.03 and mean ± SD, RI of 113.43 ± 278.51). There was no significant difference in the occurrence of ANCs between the two groups. Conclusion Nonbypass cardiac surgery produces relative beneficial effect on pulmonary gas exchange. However, this does not translate in clinical practice in terms of ventilator time or postoperative hospital stay. There was no beneficial effect of nonbypass cardiac surgery over bypass cardiac surgery regarding postoperative ANCs.

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