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Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
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Experience with the Norwood procedure without circulatory arrest
1Cardiovascular Surgery, Fukuoka Children's Hospital, Kyusyu University, Fukuoka, Japan.
The Journal of Thoracic and Cardiovascular Surgery
|November 2, 2001
Summary
This study introduces a novel cardiopulmonary bypass technique for hypoplastic left heart syndrome, successfully avoiding circulatory arrest and deep hypothermia during the Norwood procedure. Survivors showed stable recovery without neurological deficits.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Congenital Heart Defect Management
Background:
- Hypoplastic left heart syndrome (HLHS) presents significant surgical challenges.
- The Norwood procedure traditionally involves circulatory arrest and deep hypothermia, carrying inherent risks.
- Developing safer bypass techniques is crucial for improving outcomes in HLHS patients.
Purpose of the Study:
- To evaluate a new cardiopulmonary bypass technique for the Norwood procedure in HLHS.
- To assess the feasibility of completely avoiding circulatory arrest and deep hypothermia.
- To determine the safety and efficacy of an alternative pulmonary blood source.
Main Methods:
- A novel Y-shaped cardiopulmonary bypass circuit was employed for dual cerebral and lower body perfusion.
- Moderate hypothermia (29-31°C) and high pump flow (150-180 mL/kg/min) were utilized.
- A right ventricle-to-pulmonary artery conduit was used in 6 patients as an alternative pulmonary blood source.
Main Results:
- Complete avoidance of circulatory arrest was achieved in all 10 patients.
- No complications related to the new bypass technique were observed.
- Survivors exhibited stable postoperative courses, satisfactory renal function, and no neurological deficits; 3 early deaths occurred.
Conclusions:
- The modified Norwood procedure successfully eliminated circulatory arrest using innominate artery perfusion and descending aorta cannulation.
- A right ventricle-to-pulmonary artery conduit is a promising alternative pulmonary blood source, though RV function requires monitoring.
- This technique offers a potentially safer approach to managing HLHS.
