Abstract
Background
Selective cerebral perfusion avoids deep hypothermic circulatory arrest in single-stage repair of the aortic arch and associated cardiac defects in neonates and infants. Direct innominate artery cannulation is accepted as a safe technique to obtain this objective.
Methods
From February 2012 to September 2014, 21 patients underwent one-stage repair of aortic arch anomalies associated with intracardiac defects. The age ranged from 16 days to 1 year (median age 2 months). There were six neonates. The weight ranged from 2.4 to 8 kg (median weight 3.5 kg).Two infants had coarctation with diffuse aortic arch hypoplasia, without any associated intracardiac defect. The rest had significant intracardiac defects which were corrected along with arch repair. Cardiopulmonary bypass was initiated with direct arterial return through the base of the innominate artery and routine venous cannulation. All patients were cooled to 24 °C. The arch repair was done using selective cerebral perfusion through the innominate artery with a flow rate of 40 mL/kg/min. After the arch repair, normal bypass was reestablished and intracardiac defects were repaired.
Results
There was no mortality. There was no evidence of obvious neurologic injury. All patients had unobstructed flow in the arch repair during intermediate follow-up.
Conclusions
Selective cerebral perfusion with direct innominate artery cannulation for arch repair extends the safety of arch repair. The major advantage of this technique is the feasibility to perform a wide end to side anastomosis without space constraint and ability to repair associated cardiac lesions.
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Accepted for oral presentation in the IACTS February 2015 Annual Conference.
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Dharmapuram, A.K., Ramadoss, N., Goutami, V. et al. Single-stage repair of aortic arch and associated cardiac defects with antegrade cerebral perfusion using direct innominate artery cannulation in neonates and infants. Indian J Thorac Cardiovasc Surg 31, 127–132 (2015). https://doi.org/10.1007/s12055-015-0367-4
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DOI: https://doi.org/10.1007/s12055-015-0367-4