Clinical implications of ventricular fibrillation vs. heart-beating technique during cardiopulmonary bypass for pulmonary valve replacement

Abstract

Objectives : This is a retrospective study of patients with repaired tetralogy of Fallot (TOF) who received cardiopulmonary bypass (CPB) for simple pulmonary valve replacement (PVR). We compare the clinical outcomes of patients with ventricular fibrillation with those who had a beating heart during CPB. Methods : We retrospectively reviewed the data of 47 repaired TOF patients at a single institution who received simple PVR under ventricular fibrillation or beating heart without cardioplegic cardiac arrest during CPB from January 2005 to April 2015. Results : Patients were divided into fibrillation (n = 32) and beating heart (n = 15) groups. The fibrillation group had a larger sinotubular junction (27.1 ± 4.6 vs. 22.1 ± 2.4 mm, P = 0.006), longer duration of operation (396 ± 108 vs. 345 ± 57 min, P = 0.039), required more postoperative transfusions (2.1 ± 2.6 vs. 5.0 ± 6.3 units, P = 0.03), and needed more vasoactive-inotropic score at admission to the ICU (8.0 vs. 10, P = 0.008). Echocardiographic data indicated the systolic internal diameter of the left ventricle (LV) was larger in fibrillation group immediately after surgery and at the 1-year follow-up. Major adverse cardiac events occurred in 3 cases, all in the fibrillation group. Among the 7 patients in the fibrillation group with trans-esophageal echocardiography data during CPB, 6 had fully opened aortic valves during fibrillations, resulting in flooding into the LV and LV distension. Conclusions : Ventricular fibrillation technique during CPB for PVR in patients with repaired TOF is associated with worse postoperative outcomes than the heart-beating technique.