Uso da circulação extracorpórea em neonatos com cardiopatias congênitas
DOI:
https://doi.org/10.34119/bjhrv8n5-156Keywords:
circulação extracorpórea, cardiopatias congênitas, cirurgia cardíacaAbstract
A circulação extracorpórea (CEC) desempenha um papel crucial no tratamento cirúrgico de neonatos com cardiopatias congênitas complexas, proporcionando suporte circulatório e respiratório durante procedimentos de alta complexidade. No entanto, o uso da CEC nessa população vulnerável está associado a uma série de complicações graves, incluindo disfunção neurológica, insuficiência renal aguda, complicações pulmonares e distúrbios hemostáticos. Estas complicações são exacerbadas pelas características fisiológicas únicas dos neonatos, como a imaturidade dos sistemas cardiovascular e imunológico, além do estado transitório da circulação fetal para a neonatal. Avanços recentes, como circuitos de perfusão com menor volume de isenção, técnicas de perfusão de baixo fluxo e a monitorização cerebral contínua por espectroscopia de infravermelho próximo (NIRS), têm contribuído significativamente para a melhoria dos desfechos clínicos. Apesar desses progressos, o manejo da CEC em neonatos continua a representar um desafio, exigindo adaptações contínuas nas estratégias perioperatórias e pós-operatórias para mitigar complicações e melhorar a sobrevida. As perspectivas futuras incluem a aplicação de inteligência artificial para personalizar a perfusão, novos biomateriais para circuitos de CEC mais biocompatíveis e o uso de terapias regenerativas, como células-tronco, que podem revolucionar o tratamento cirúrgico de cardiopatias congênitas. O presente artigo revisa criticamente os avanços, desafios e futuras direções no uso da CEC em neonatos com cardiopatias congênitas, com ênfase nas melhores práticas e na necessidade de pesquisas adicionais para aprimorar os resultados clínicos.
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