• Jane W Newburger, Richard A Jonas, Janet Soul, Barry D Kussman, David C Bellinger, Peter C Laussen, Richard Robertson, John E Mayer, Pedro J del Nido, Emile A Bacha, Joseph M Forbess, Frank Pigula, Stephen J Roth, Karen J Visconti, Adre J du Plessis, David M Farrell, Ellen McGrath, Leonard A Rappaport, and David Wypij.
• Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA. jane.newburger@cardio.chboston.org
• J. Thorac. Cardiovasc. Surg. 2008 Feb 1;135(2):347-54, 354.e1-4.

ObjectivesWe previously reported that postoperative hemodynamics and developmental outcomes were better among infants randomized to a higher hematocrit value during hypothermic cardiopulmonary bypass. However, worse outcomes were concentrated in patients with hematocrit values of 20% or below, and the benefits of hematocrit values higher than 25% were uncertain.MethodsWe compared perioperative hemodynamics and, at 1 year, developmental outcome and brain magnetic resonance imaging in a single-center, randomized trial of hemodilution to a hematocrit value of 25% versus 35% during hypothermic radiopulmonary bypass for reparative heart surgery in infants undergoing 2-ventricle repairs without aortic arch obstruction.ResultsAmong 124 subjects, 56 were assigned to the lower-hematocrit strategy (24.8% +/- 3.1%, mean +/- SD) and 68 to the higher-hematocrit strategy (32.6% +/- 3.5%). Infants randomized to the 25% strategy, compared with the 35% strategy, had a more positive intraoperative fluid balance (P = .007) and lower regional cerebral oxygen saturation at 10 minutes after cooling (P = .04) and onset of low flow (P = .03). Infants with dextro-transposition of the great arteries in the 25% group had significantly longer hospital stay. Other postoperative outcomes, blood product usage, and adverse events were similar in the treatment groups. At age 1 year (n = 106), the treatment groups had similar scores on the Psychomotor and Mental Development Indexes of the Bayley Scales; both groups scored significantly worse than population norms.ConclusionsHemodilution to hematocrit levels of 35% compared with those of 25% had no major benefits or risks overall among infants undergoing 2-ventricle repair. Developmental outcomes at age 1 year in both randomized groups were below those in the normative population.

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