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Murine Cervical Aortic Transplantation Model using a Modified Non-Suture Cuff Technique
Published on: November 2, 2019
Neonatal aortic arch reconstruction avoiding circulatory arrest and direct arch vessel cannulation
C I Tchervenkov1, S J Korkola, D Shum-Tim
1Division of Cardiovascular Surgery, The Montréal Children's Hospital, McGill University Health Center, Québec, Canada. christo.tchervenkov@muhc.mcgill.ca
The Annals of Thoracic Surgery
|November 28, 2001
Summary
Neonatal aortic arch reconstruction can be performed without circulatory arrest using continuous low-flow cerebral perfusion (LFCP). This method ensures adequate oxygen saturation and avoids adverse neurologic outcomes in infants.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Neonatal Intensive Care
Background:
- Aortic arch reconstruction in neonates typically necessitates deep hypothermic circulatory arrest.
- This study investigates alternative techniques using continuous low-flow cerebral perfusion (LFCP) to avoid direct arch vessel cannulation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of LFCP in neonatal aortic arch reconstruction.
- To assess the efficacy of LFCP in maintaining cerebral perfusion and preventing neurologic complications.
Main Methods:
- Eighteen neonates underwent aortic arch reconstruction utilizing LFCP, with varying surgical approaches including biventricular repairs, Norwood operations, and isolated arch repairs.
- LFCP was achieved through different cannulation strategies, such as advancing the cannula into the innominate artery or perfusing via a modified Blalock-Taussig shunt.
Main Results:
- LFCP was maintained at a flow rate of 0.6 ± 0.2 L/min/m² for 41.0 ± 13.9 minutes at a temperature of 18.5 ± 1.1°C.
- Adequate mixed-venous oxygen saturation (79.8% ± 10%) was achieved during LFCP.
- No postoperative seizures were observed, contrasting with two preoperative seizures, and one patient mortality occurred.
Conclusions:
- Neonatal aortic arch reconstruction is achievable without circulatory arrest or direct arch vessel cannulation.
- LFCP techniques effectively maintained adequate mixed-venous oxygen saturation.
- These methods demonstrated no associated adverse neurologic outcomes in the studied neonates.
