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[One-stage repair of interrupted aortic arch with selective cerebral perfusion]
T Takeuchi1, Y Harada, K Morishima
1Department of Cardiovascular Surgery, Nagano Children's Hospital, Japan.
Insights
Selective cerebral perfusion using EPTFE grafts during circulatory arrest effectively protected against neurological complications in infants undergoing interrupted aortic arch repair. This technique may reduce brain damage risks in complex pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Neurological Protection
Context:
- Interrupted aortic arch (IAA) repair often requires circulatory arrest, posing a risk of neurological injury.
- Minimizing neurological compromise is critical in complex congenital heart defect surgeries.
- Selective cerebral perfusion (SCP) is a potential strategy to mitigate these risks.
Purpose:
- To evaluate the efficacy of selective cerebral perfusion via an expanded polytetrafluoroethylene (ePTFE) graft in preventing neurological damage during one-stage interrupted aortic arch repair in infants.
- To assess the safety and neurological outcomes associated with this surgical approach.
Summary:
- Six infants (12 days to 4 months old) with interrupted aortic arch and intracardiac anomalies underwent one-stage repair using selective cerebral perfusion.
- Cardiopulmonary bypass was established with dual pump systems, and cerebral perfusion was maintained via an ePTFE graft at 10 ml/kg/min during circulatory arrest.
- Following arch repair, total systemic perfusion resumed, and intracardiac repairs were completed. No operative deaths or neurological complications were observed; post-operative neurological evaluations were normal for age.
Impact:
- Selective cerebral perfusion using ePTFE grafts appears to be a safe and effective method for protecting the brain during complex aortic arch repairs in infants.
- This technique may significantly reduce the incidence of neurological complications and brain damage in this high-risk pediatric population.
- The findings support the broader adoption of SCP in pediatric cardiac surgery to enhance patient outcomes.
Abstract:
To minimize the neurological compromise after the circulatory arrest, the selective cerebral perfusion could be beneficial. We underwent one-stage repair of the interrupted aortic arch (IAA) with various intracardiac anomalies for the six patients, age ranging from 12 days to 4 months, by using the selective cerebral perfusion. Cardiopulmonary bypass was established by using two-way arterial cannulation supported by the two respective pump systems, one of which utilized the EPTFE graft anastmosed to either the bracheocephalic artery or the right subclavian artery and second of which enrouted through the arterial ductus to the descending aorta. The cerebral perfusion during the circulatory arrest for the aortic arch repair was maintained by the selective perfusion via EPTFE graft with 10 ml/kg/min blood flow. After the completion of the arch repair, the total system perfusion was restarted through the graft and the repair of the intracardiac anomalies was followed. Of six, no operative death or neurological complications related to the operation were found. The clinical neurological evaluation after operation also demonstrated the normal for the age. In conclusion, the selective cerebral perfusion by using the EPTFE graft during the circulatory arrest might decrease the risk of brain damage.