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Preliminary results of fetal cardiac bypass in nonhuman primates.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2005 Jan; Vol. 129 (1), pp. 175-81. - Publication Year :
- 2005
-
Abstract
- Objective: Fetal cardiac surgery has potential benefits for treatment of some congenital heart defects. However, placental dysfunction as a result of fetal bypass, fetal stress, and fetal exposure to external milieu needs to be overcome to optimize the outcomes of fetal cardiac bypass. In this study we evaluated the technical feasibility of cardiac bypass in the nonhuman primate fetus and the efficacy of different anesthetic approaches.<br />Methods: Twelve baboon fetuses, average gestation 146 +/- 8 days and weight 696 +/- 184 g, were used. Three fetuses were excluded from the study because of nuchal cord presentations. The animals were separated into two anesthesia groups: isoflurane (n = 6) and fentanyl and midazolam (n = 3). A miniature roller pump circuit without oxygenator was used for fetal bypass for 30 minutes. No blood transfusion was performed. Fetal blood gas samples were collected before bypass, during bypass, and at 15 and 60 minutes after bypass.<br />Results: All fetuses in the isoflurane group were successfully placed on the cardiac bypass circuit. However, 2 animals in the fentanyl and midazolam group were not placed on the bypass circuit because of sustained elevation in maternal uterine tone. All maternal baboons survived. Of the 6 fetuses in the isoflurane group, 5 survived for 60 minutes; however, placental function continued to deteriorate after bypass (Pa o 2 33 +/- 3 mm Hg before bypass, 23 +/- 6 mm Hg 15 minutes after, and 18 +/- 9 mm Hg 60 minutes after).<br />Conclusion: The technical feasibility of cardiac bypass in nonhuman primate fetuses weighing less than 1000 g was confirmed. Isoflurane anesthesia appears to be superior to fentanyl and midazolam anesthesia for fetal cardiac surgery because of adequate uterine relaxation.
- Subjects :
- Anesthesia, General methods
Animals
Blood Gas Analysis
Blood Pressure Determination
Cardiac Output
Female
Fentanyl administration & dosage
Fetal Heart abnormalities
Hemodynamics physiology
Isoflurane administration & dosage
Papio
Pregnancy
Sensitivity and Specificity
Statistics, Nonparametric
Treatment Outcome
Anesthetics, Intravenous administration & dosage
Cardiopulmonary Bypass methods
Fetal Heart surgery
Pregnancy, Animal
Subjects
Details
- Language :
- English
- ISSN :
- 0022-5223
- Volume :
- 129
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 15632840
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2004.09.003