Norwood reconstruction using continuous coronary perfusion: a safe and translatable technique

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Repair
• Cardiovascular Surgical Techniques

Background:

• Continuous coronary perfusion during Norwood reconstruction may reduce postoperative cardiac dysfunction.
• Avoiding cardiac arrest allows for more deliberate aortic reconstruction with a beating heart.
• This study compares outcomes of continuous coronary perfusion versus standard cardiac arrest for Norwood reconstruction.

Purpose of the Study:

• To compare patient outcomes between continuous coronary perfusion and standard cardiac arrest during Norwood reconstruction.
• To evaluate the safety and efficacy of a beating-heart approach for Norwood procedures.
• To assess the impact of continuous coronary perfusion on survival, cardiac function, and metabolic markers.

Main Methods:

• Retrospective review of 32 patients undergoing Norwood reconstruction (2004-2011).
• 16 patients received deep hypothermia with continuous coronary and cerebral perfusion (beating-heart group).
• 16 patients underwent deep hypothermia, selective cerebral perfusion, and cardioplegic arrest (standard group).

Main Results:

• Survival was 87.5% in the beating-heart group vs. 62.5% in the standard group (p=0.22).
• No beating-heart patients required extracorporeal membrane oxygenation, versus 3 in the standard group.
• Lower peak lactate levels were observed in the beating-heart group (8.2 mEq/L vs. 10.7 mEq/L, p=0.022).

Conclusions:

• Continuous coronary perfusion is applicable to all aortic sizes during Norwood reconstruction.
• This technique is a safe alternative, demonstrating non-inferior outcomes in survival, ECMO use, cardiac function, and lactate levels.
• This study represents the largest series of Norwood operations utilizing continuous coronary perfusion for aortic augmentation.