Modified single innominate artery cannulation with low flow cardiopulmonary bypass during repair of interrupted aortic arch
Chen et al. Journal of Cardiothoracic Surgery
Modified single innominate artery cannulation with low flow cardiopulmonary bypass during repair of interrupted aortic arch
Q Chen 2
M Caputo 2
S Stoica 2
G Stuart 1
A Wolf 0
A Parry 2
0 Cardiac Anaesthesia, Bristol Royal Hospital for Children , Bristol , UK
1 Cardiology, Bristol Royal Hospital for Children , Bristol , UK
2 Cardiac Surgery, Bristol Royal Hospital for Children , Bristol , UK
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From 23rd World Congress of the World Society of Cardio-Thoracic Surgeons
Split, Croatia. 12-15 September 2013
Background
Conventional techniques for repairing interrupted aortic
arch (IAA) using deep hypothermic circulatory arrest
(DHCA) is known to be associated with the risk of
postoperative neurological injury. We have used alternative
technique with direct innominate artery cannulation for
continuous cerebral perfusion, without DHCA, during
repair of IAA in neonates regardless of patients weight.
Methods
Between September 1999 and July 2011, 32 consecutive
children with IAA (13 type A, 19 type B) underwent
repair using continuous, hypothermic (18 C) low flow
CPB without circulatory arrest. Associated cardiac
lesions were Truncus Arteriosus (4), VSD (22), DORV
(2), aortopulmonary window (4). Associated cardiac
lesions were corrected in all except the DORV which
were banded.
Results
Age at time of surgery was 7 days (4-120 days) and
weight 3.1 kg (2.1 to 5.8 kg). Selective cerebral perfusion
was maintained in all patients throughout aortic
reconstruction. During the period of selective cerebral
perfusion, pump flow rate was maintained at 30 mls/kg/min.
Aortic cross clamp time, low-flow, and total CPB time
were 66 (42-114), 29 (18-41) and 109 (83-217) minutes,
respectively. There were no deaths or neurological injury
in this series. Postoperative ventilation time, and length
of ICU and hospital stay were 3 (2-14), 5 (3-21), and
13 (6-27) days, respectively. Follow-up, complete at
48 months (21-156), revealed no late neurologic sequelae
* Correspondence:
1Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
Full list of author information is available at the end of the article
nor innominate artery complications. There were three
late re-stenosis of the aortic arch requiring balloon
dilatation in 2 and surgical repair in 1.
Conclusions
Direct innominate arterial cannulation with continuous
selective cerebral perfusion can be safely applied during
repair of IAA even with low birth weight neonates. It is
technical simple and associated with excellent clinical
outcomes.
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