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Modified Technique for the Use of Neonatal Murine Hearts in the Langendorff Preparation
Published on: March 4, 2022
Continuous cerebral and myocardial perfusion during aortic arch repair in neonates and infants
Yasuhiro Kotani1, Kozo Ishino, Shingo Kasahara
1Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Insights
Minimizing myocardial ischemia during aortic arch repair in infants is crucial. Both non-working beating heart and working beating heart techniques offer effective strategies for complex congenital heart defect repair, ensuring high survival rates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Cardiovascular Perfusion
Background:
- Aortic arch obstruction combined with ventricular septal defects presents complex surgical challenges.
- Minimizing myocardial ischemia during repair is critical for infant outcomes.
- Cerebral and myocardial perfusion strategies are vital for protecting the infant heart during surgery.
Purpose of the Study:
- To compare two distinct perfusion techniques for minimizing myocardial ischemia during aortic arch repair in infants with ventricular septal defects.
- To evaluate the efficacy and safety of non-working beating heart (NWBH) versus working beating heart (WBH) techniques.
- To assess the impact of these techniques on surgical outcomes and survival rates.
Main Methods:
- Retrospective analysis of 71 infants undergoing primary repair of coarctation of the aorta or interruption of the aortic arch with ventricular septal defect.
- Comparison of end-to-end arch anastomosis using NWBH (n=65) with cerebral/myocardial perfusion via innominate/ascending cannula versus WBH (n=6) with innominate artery cannulation and cross-clamping.
- Detailed assessment of myocardial ischemia, need for cardioplegic arrest, and procedural success.
Main Results:
- The working beating heart (WBH) technique successfully completed extended arch anastomoses without myocardial ischemia in all 6 patients.
- Ten patients (15%) undergoing the non-working beating heart (NWBH) technique required cardioplegic arrest for anastomosis.
- Overall survival was high at 98%, with one hospital death and one late death.
Conclusions:
- End-to-end arch reconstruction is feasible and can be achieved without myocardial ischemia.
- The NWBH technique is suitable for patients without hypoplastic arches.
- The WBH technique is advantageous for patients with hypoplastic arches, ensuring myocardial protection.
Abstract:
To minimize myocardial ischemia, we repaired aortic arch obstruction with ventricular septal defect, using two different techniques of cerebral and myocardial perfusion. Seventy-one infants, ages 3 to 137 days, underwent primary repair of coarctation of the aorta (n = 49)/interruption of the aortic arch (n = 22) with ventricular septal defect. In 65 patients, an end-to-end arch anastomosis was performed with cerebral and myocardial perfusion through the innominate or the ascending arterial cannula (non-working beating heart: NWBH). In the remaining 6 patients, an arterial cannula was placed into the innominate artery. With partial cardiopulmonary bypass, the innominate artery was snared proximal to the cannulation site and the ascending aorta was cross-clamped. An extended arch anastomosis was carried out with cerebral perfusion and a working beating heart (WBH). Ten patients (15%) undergoing aortic arch repair with the NWBH technique required cardioplegic arrest to complete a proximal anastomosis, whereas in all 6 repairs with the WBH technique, the extended anastomoses were completed without myocardial ischemia. One hospital death and late death occurred, with an overall survival of 98%. End-to-end arch reconstruction is feasible without myocardial ischemia, using the NWBH technique in patients without hypoplastic arch and using the WBH technique in patients with hypoplastic arch.
