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Beating heart thoracic aortic surgery under selective myocardial perfusion for patients with congenital aortic anomalies

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Abstract

Objective

We evaluated beating heart thoracic aortic surgery (BHTAS) using selective myocardial perfusion (SMP) in patients with aortic anomalies with complex surgical needs.

Methods

Between 2012 and 2018, 27 infants with aortic anomalies underwent BHTAS using SMP.

Results

Median body weight was 3.5 kg (range 2.6–5.2). In total, 15 cases of aortic coarctation, 7 cases of hypoplastic left heart syndrome, and 5 cases of interrupted aortic arch were included. An extended aortic arch anastomosis maneuver was used in 7 cases and aortic arch reconstruction compensated with an autologous pericardium patch was used in 6 cases. A Norwood-type procedure was used in 11 cases. The median Aristotle comprehensive score was 13.9 (7.0–20.0). BHTAS cases were not inferior in postoperative CK-MB/CK ratio (12.4 ± 2.8 in BHTAS vs 13.9 ± 3.6 in CTAS, p = 0.09), and there were no instances of myocardial ischemia. Two late deaths occurred due to shunt obstruction (n = 1) and valve malfunction (n = 1). Freedom from aortic reintervention was not inferior to conventional thoracic aortic surgery. BHTAS cases exhibited shorter cardiac arrest time than that of conventional thoracic aortic surgery in similar surgical procedures [CoA/VSD cases: 48.0 ± 8.0 min in the BHTAS cases and 65.7 ± 10.8 min in the CTAS cases (p = 0.0122), simple CoA/re-CoA cases: 0 min in the BHTAS cases and 20.1 ± 3.6 min in the CTAS cases].

Conclusions

BHTAS reduced cardioplegic arrest time while maintaining postoperative CK-MB/CK ratio, mid-term death, and aortic reintervention rates.

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Authors and Affiliations

  1. Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Arakawa 118-1, Haebaru-cho, Okinawa, 901-1193, Japan

    Tai Fuchigami, Masahiko Nishioka & Nobuhiro Nagata

  2. Department of Clinical Engineering, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Arakawa 118-1, Haebaru-cho, Okinawa, 901-1193, Japan

    Yutaka Tamashiro

Authors
  1. Tai Fuchigami
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  2. Masahiko Nishioka
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  3. Yutaka Tamashiro
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  4. Nobuhiro Nagata
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Correspondence to Tai Fuchigami.

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11748_2020_1304_MOESM1_ESM.jpg

Supplementary material section S1. Beating heart thoracic aortic surgery circuit. Schema of arterial circuit (A) and actual arterial circuit (B). A cardioplegic spike or tip was placed at the proximal ascending aorta and connected to the side arm of the arterial circuit using an extension tube with a one-way valve. CP = cardioplegic; DAo = descending aorta; ePTFE = expanded polytetrafluoroethylene; SCP = selective cerebral perfusion; SMP = selective myocardial perfusion (JPG 84 kb)

11748_2020_1304_MOESM2_ESM.jpg

Supplementary material section S2. Cases of BHTAS and CTAS. Number of patients. BHTAS = beating heart thoracic aortic surgery; CTAS = conventional thoracic aortic surgery (JPG 83 kb)

11748_2020_1304_MOESM3_ESM.jpg

Supplementary material section S3. Temporal measurements of CK and CK-MB. *1: Just after cardiopulmonary bypass initiation. *2: Just after cardiac surgery. *3: Postoperative day 1. *4: Postoperative day 2. CK = creatine kinase; CK-MB = creatine kinase MB isoenzyme (JPG 39 kb)

11748_2020_1304_MOESM4_ESM.mpg

Supplementary Video 1. BHTAS using ordinary cardioplegic spike. AAo = ascending aorta; ASO = arterial switch operation; BHTAS = beating heart thoracic aortic surgery; CP = cardioplegic; DAo = descending aorta; EAAA = extended aortic arch anastomosis; IVR = intraventricular rerouting (MPG 70902 kb)

11748_2020_1304_MOESM5_ESM.mpg

Video 2. BHTAS for hypoplastic aorta. AAo = ascending aorta; BHTAS = beating heart thoracic aortic surgery; CP = cardioplegic; HLHS = hypoplastic left heart syndrome; INNA = innominate artery (MPG 107664 kb)

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Fuchigami, T., Nishioka, M., Tamashiro, Y. et al. Beating heart thoracic aortic surgery under selective myocardial perfusion for patients with congenital aortic anomalies. Gen Thorac Cardiovasc Surg 68, 956–961 (2020). https://doi.org/10.1007/s11748-020-01304-7

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  • DOI: https://doi.org/10.1007/s11748-020-01304-7

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