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Avoiding use of total circulatory arrest in the practice of congenital heart surgery

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Deep hypothermic circulatory arrest (DHCA) technique has been an important armamentarium in the correction of congenital heart diseases. There have been many controversies and concerns associated with DHCA, particularly neurological damage. Selective ante grade cerebral perfusion (SACP) was introduced as an adjunct to DHCA with the objective of limiting the neurologic injury during aortic arch repairs. Over the past two decades, various aspects of cardiopulmonary bypass and DHCA have been studied and modified such as optimisation of flows, anti-inflammatory interventions, haematocrit, and temperature to improve neurologic outcomes. With the changes in practice of DHCA, outcomes have significantly improved but SACP intuitively appears attractive to offer better neuroprotection. The strategy of conduct of SACP is evolving and needs to be standardised for comparing outcomes. In this review we have discussed the various physiological and technical factors involved in conduct of SACP in paediatric cardiac surgery and outcomes with SACP.

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Authors and Affiliations

  1. Paediatric Cardiac Anaesthesiology, Division of Paediatric Cardiac Sciences, Krishna Institute of Medical Sciences (KIMS Hospitals), Minister Road, Secunderabad, 500003, India

    Nagarajan Ramadoss

  2. Paediatric Cardiac Surgery, Division of Paediatric Cardiac Sciences, Krishna Institute of Medical Sciences (KIMS Hospitals), Minister Road, Secunderabad, 500003, India

    Anil Kumar Dharmapuram

  3. Paediatric Cardiology, Division of Paediatric Cardiac Sciences, Krishna Institute of Medical Sciences (KIMS Hospitals), Minister Road, Secunderabad, 500003, India

    Vejendla Goutami & Sudeep Verma

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  1. Nagarajan Ramadoss
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  2. Anil Kumar Dharmapuram
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  3. Vejendla Goutami
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  4. Sudeep Verma
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Correspondence to Anil Kumar Dharmapuram.

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Ramadoss, N., Dharmapuram, A.K., Goutami, V. et al. Avoiding use of total circulatory arrest in the practice of congenital heart surgery. Indian J Thorac Cardiovasc Surg 37 (Suppl 1), 174–182 (2021). https://doi.org/10.1007/s12055-020-00955-8

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