Continuous systemic perfusion improves outcome in one stage repair of obstructed aortic arch and associated cardiac
H Uemura1, T Yagihara, Y Kawahira
1Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Osaka, Japan. huemura@hsp.ncvc.go.jp
Insights
Continuous systemic perfusion is a less invasive approach for repairing aortic obstructions and heart defects in infants. This method resulted in fewer complications and better outcomes compared to circulatory arrest techniques.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Aortic obstruction and associated cardiac malformations require complex surgical repair in infants.
- Traditional methods involving circulatory arrest can lead to significant complications.
- Exploring alternative perfusion strategies is crucial for improving surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous systemic perfusion during primary repair of aortic obstruction and congenital heart defects.
- To compare outcomes between continuous systemic perfusion and circulatory arrest techniques in infant cardiac surgery.
Main Methods:
- Retrospective analysis of 56 infants undergoing aortic reconstruction (interrupted or coarctated) with cardiac malformation repair since 1991.
- Comparison of three perfusion strategies: total circulatory arrest (23 patients), selective carotid artery perfusion with descending aorta cross-clamping (21 patients), and continuous systemic perfusion via dual aortic cannulae (12 patients).
- Assessment of postoperative outcomes, including survival, complications, and biochemical markers.
Main Results:
- The continuous systemic perfusion group (no circulatory arrest) experienced fewer postoperative complications, including no cerebral bleeding and shorter tracheal intubation needs.
- Patients in the non-circulatory arrest group showed significantly greater urine output during cardiopulmonary bypass.
- Lower maximal concentrations of urinary beta-microglobulin, serum creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were observed in the non-circulatory arrest group.
Conclusions:
- Continuous systemic perfusion is a less invasive and effective method for repairing aortic obstructions and intracardiac malformations in infants.
- This technique is associated with improved postoperative recovery and reduced organ-specific injury markers.
- The findings support the adoption of continuous systemic perfusion as a preferred strategy in complex pediatric cardiac surgery.
Objective:
To determine whether continuous systemic perfusion is of effective use when establishing primary repair of the aortic obstruction and associated cardiac malformations.
Methods:
Since 1991, 56 infants have undergone reconstruction of interrupted (in 28) or coarctated (in 28) aorta, concomitantly with closure of ventricular septal defects in 37, and repair of other malformations in the remaining 19. Of these, total circulatory arrest (30+/-11 min) was employed in 23. In another 21 patients, perfusion was maintained for the carotid arteries with the descending aorta cross-clamped (31+/-15 min). The bodily organs were perfused throughout the operative procedures by placing dual aortic cannulae in the remaining 12 patients.
Results:
The postoperative courses were less eventful in the non-circulatory arrest group than other groups of patients undergoing total or partial circulatory arrest, although these groups were operated in different time periods, and consequently, a general progress might be one reason for improvements in the surgical outcomes. All patients undergoing no circulatory arrest survived the primary repair, could have the sternum primarily closed, and had no episodes of cerebral bleeding. Prolonged tracheal intubation was needed just in one patient of this group. The amount of urine output during cardiopulmonary bypass was significantly greater in the non-circulatory arrest group than in the others. The maximal concentrations of urinary beta-microglobulin, serous creatinine, creatine phosphokinase, and glutamic oxaloacetic transaminase were lower in this setting.
Conclusions:
Continuous systemic perfusion was considered less invasive when concomitantly repairing the obstructed aorta and intracardiac malformations.
