Open Cardiac Surgery in the First Hours of Life Using Autologous Umbilical Cord Blood

OBJECTIVE:

This article describes the first clinical experience of complete repair of complex critical congenital heart diseases (CHDs) in the first hours of life using autologous umbilical cord blood (UCB). Prenatal diagnosis and harvesting of autologous UCB allow to modify perioperative management and to perform corrective surgery in the first hours of a patient’s life. This approach can afford avoiding homologous blood transfusion and preventing development of hypoxemia and heart failure due to hemodynamic changes of complex critical CHD.

METHODS:

The study group included 14 consecutive prenatally diagnosed patients with critical complex CHD during the period from September 2009 to August 2010. Autologous UCB was harvested in accordance to NetCord-FACT International Standards for Cord Blood Collection and was used during the surgery with cardiopulmonary bypass (CPB). In all cases, complete repair was performed during the first hours of life: arterial switch operation (n=9); arterial switch operation with total anomalous pulmonary venous communication repair (n=1); arterial switch operation with interruption of the aortic arch repair (n=1); Ebstein’s repair (n=2); and aortopulmonary window repair with interruption of the aortic arch repair (n=1). All procedures were performed using moderate hypothermia with cold-crystalloid cardioplegia, except one case that required deep hypothermic circulatory arrest.

RESULTS:

A mean of 92±16 ml of UCB was harvested. Autologous UCB was used during the surgery in all 14 cases. Mean age of newborns at operation was 4.7±2 h (3-8). No patients required intensive care unit (ICU) admission, interventional procedures, mechanical ventilation, or medications before surgery. Twelve patients underwent bloodless open heart surgery; eight of them completely avoided homologous blood transfusion during the perioperative period. There was one postoperative death in our study (Ebstein’s anomaly).

CONCLUSIONS:

The use of autologous umbilical cord blood is feasible in neonatal open heart surgery. Complete surgical repair of complex critical CHD can be applied successfully to neonates within the first hours of life.