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[Descending aorta perfusion through median sternotomy in primary repair of aortic interruption complex]
1Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Japan.
Insights
This study presents a novel technique for infant aortic arch reconstruction using descending aorta cannulation. This method ensures continuous perfusion, minimizing risks of acute renal failure and neurological deficits in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Neonatal Surgery
Background:
- Aortic arch reconstruction in infants often involves circulatory arrest, posing risks of acute renal failure and neurological deficits.
- Traditional methods may not adequately protect end-organ perfusion during complex aortic arch repairs.
Observation:
- A novel technique for aortic arch reconstruction in a one-month-old infant involved cannulating the descending aorta after initial extracorporeal circulation setup.
- This allowed for continuous perfusion to the brain and lower body during arch reconstruction and ventricular septal defect closure.
Findings:
- The procedure utilized bicaval venous cannulae and arterial cannulae in the pulmonary trunk and innominate artery, with subsequent descending aorta cannulation.
- Extracorporeal circulation and aortic cross-clamp times were 117 minutes and 21 minutes, respectively.
- Excellent postoperative renal function and no neurological deficits were observed.
Implications:
- Descending aorta cannulation is a safe and effective technique for infant aortic arch reconstruction.
- This approach may reduce the incidence of postoperative complications associated with circulatory arrest in pediatric cardiac surgery.
- Further studies are warranted to validate this technique in a larger cohort of infants undergoing aortic arch repair.
Abstract:
Circulatory arrest is frequently used in aortic arch reconstruction in pediatric cardiac surgery. However, risks of postoperative acute renal failure and neurological deficit can not be ignored. We performed primary repair of aortic interruption in one-month old girl. After commencing extracorporeal circulation with bicaval venous cannulae and with arterial cannulae into the pulmonary trunk and the innominate artery, the descending aorta was cannulated just superior to the diaphragm. The cannula in the pulmonary trunk was then removed. Arch reconstruction and closure of the ventricular septal defect were performed with continuous perfusion to the brain and the lower body. The extracorporeal circulation time and the aortic cross-clamp time were 117 min and 21 min, respectively. Postoperative renal function was excellent, and there was no finding of neurological deficit. Cannulation of the descending aorta is a simple and useful technique with safety, in arch reconstruction in infants.