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Heart transplantation for hypoplastic left heart syndrome: modified technique for reducing circulatory arrest time
L A Vricella1, A J Razzouk, M del Rio
1Division of Cardiothoracic Surgery, Loma Linda University Medical Center and Children's Hospital, Calif 92354, USA.
Background:
The surgical technique of heart transplantation as therapy in infants with hypoplastic left heart syndrome was first reported over a decade ago. Since that time, incremental refinements have evolved that both facilitate the operation and potentially reduce the perceived neurologic hazards associated with the use of hypothermic circulatory arrest.
Methods:
Minor technical adjustments have permitted infant heart transplantation to be accomplished with relative ease while markedly limiting the need for complete circulatory arrest. Low-flow hypothermic systemic perfusion is used for atrial implantation, reserving circulatory arrest for arch reconstruction only. This is accomplished by use of an active (pump) sucker for venous return.
Result:
Mean circulatory arrest time with the current technique has been 26 minutes.
Conclusion:
Minor technical refinements have resulted in a marked reduction in hypothermic circulatory arrest time during infant heart transplantation for hypoplastic left heart syndrome.