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Use of carotid artery cannulation during redo sternotomy in congenital cardiac surgery: a single-centre experience
Gianluca Brancaccio1, Gianluigi Perri1, Marco Della Porta1
1Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Carotid cannulation with an interposition graft is a safe and reliable technique for complex redo sternotomies in pediatric congenital heart disease patients. This method ensures adequate arterial flow and avoids neurological complications, simplifying reoperations.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Redo sternotomy in patients with congenital heart disease presents significant challenges.
- Management of arterial inflow during complex cardiac reinterventions requires specialized techniques.
Purpose of the Study:
- To evaluate the safety and efficacy of carotid cannulation with an interposition graft during redo sternotomy.
- To report single-center experience in complex cardiac reoperations for congenital diseases.
Main Methods:
- Retrospective review of 22 patients undergoing complex redo sternotomies between January 2019 and May 2020.
- Utilized cervical carotid artery cannulation with a Gore-Tex graft for arterial inflow.
- Primary outcomes assessed were survival and freedom from neurological events.
Main Results:
- Carotid graft cannulation provided adequate arterial flow (median 3.5 L/min/m²) in all patients.
- One major cardiac injury occurred during sternotomy requiring emergency cardiopulmonary bypass.
- No neurological or vascular complications or cervical wound infections were observed during hospital stays.
Conclusions:
- Carotid cannulation with an interposition graft is a reliable and safe method for initiating cardiopulmonary bypass in complex redo surgeries for congenital heart disease.
- This technique is associated with uncommon complications, facilitating surgical re-entry with low overall risks.
Objectives:
Management of resternotomy is often a difficult challenge in patients with congenital diseases who have undergone multiple sternotomies. Our goal was to report our single-centre experience with carotid cannulation using a graft interposed during redo sternotomy in complex cardiac reintervention procedures.
Methods:
We performed a retrospective review of all patients who had undergone complex redo sternotomies between January 2019 and May 2020 utilizing a cervical cannulation technique with a Gore-Tex graft interposed on the carotid artery. We classified our population study on the basis of the primary diagnosis and the type of surgery. The primary outcomes of our analysis were the evaluation of the safety of the procedure in terms of survival and freedom from neurological events.
Results:
We analysed 22 patients who had undergone previous complex operations. The median age and weight at the time of reintervention were 130.35 (range 0.46-435) months and 31.5 (range 2.2-85) kg, respectively. Composite graft carotid cannulation provided adequate arterial flow in all patients with a median arterial flow of 3.5 l/min/m2 (range 0.6-6). One major cardiac injury occurred during sternotomy when emergency cardiopulmonary bypass (CPB) was initiated. Moreover, during their hospital stays, all patients had an uneventful recovery without neurological or vascular complications and no cervical wound infections.
Conclusions:
Carotid cannulation using interposition of a side graft on the common carotid artery for arterial inflow is a reliable and safe method for initiation of CPB in complex redo surgeries in patients with congenital disease. Complications directly associated with this type of cannulation are uncommon and allow surgical re-entry with overall low risks.
