Technique for the Norwood procedure using normothermic selective cerebral perfusion

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Cardiovascular Surgery

Background:

• The Norwood procedure is a critical intervention for hypoplastic left heart syndrome.
• Current techniques often involve deep hypothermia or circulatory arrest, posing risks.
• Alternative methods are sought to improve patient outcomes.

Purpose of the Study:

• To describe a modified Norwood procedure utilizing selective cerebral perfusion.
• To maintain normothermia (> 32°C) throughout the procedure.
• To evaluate the feasibility and theoretical benefits of this approach.

Main Methods:

• Selective cerebral perfusion was employed with corporeal normothermia.
• Monitoring included right radial artery catheterization and cerebral NIRS.
• Arch isolation was achieved for a bloodless field, with perfusion via a neo-aortic cannula.

Main Results:

• The modified Norwood procedure was successfully performed.
• Cardiopulmonary bypass time was ~60 minutes; cardiac arrest time was ~20 minutes.
• Core temperature remained above 32°C, avoiding deep hypothermia.

Conclusions:

• The Norwood procedure can be safely conducted with normothermic selective cerebral perfusion.
• This technique offers a theoretical advantage by mitigating risks associated with deep hypothermia.
• Further studies are warranted to confirm long-term benefits.